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Full text of "Annual Reports of the Trustees of the Boston Psychopathic Hospital (1928-1934)"

Public Document No. 137 J~ 



ANNUAL REPORT 

OF 

THE TRUSTEES 

OF THE 

Boston Psychopathic 
Hospital o^- 

FOR THE 

YEAR ENDING NOVEMBER 30, 1928 



Department of Mental Diseases 




PUBU».AT10M or THM DoCUMBJTT AFPROVED BY THIS COMMIlMION ON ADMINWTRATION ASU FtNAXCK 

» 12-'2<). Order 702L'. 



BOARD OF TRUSTEES. 
William Healy, M.D., Chairman, Boston. 
Mrs. Esther M. Andrews, Secretary, Brookline. 
Dr. Carrie FELCHflBlsgfet^r M I^XlOfk 

Channing Frothingham, M.D., Boston. 
Allan W. Rowe, Ph.D., Boston. 
WiLLLOi J. Sullivan, Boston. OFFIC. 
Charles F. Rowley, Brookline. 

CONSULTING PHYSICL\NS. 
E. B. GooDALL, M.D., Ophthalmologist. 
G. Philip Grabfield, M.D., Internist. 
William F. Knowles, M.D., Oto-Laryngologist. 
Abraham Myerson, M.D., Neurologist. 

E. B. Sheehan, M.D., Gynecologist. 

The staffs of adjoining hospitals. 

OFFICERS OF THE HOSPITAL. 
C. Macfie Campbell, M.D., Medical Director. 
Arthur N. Ball, M.D., Chief Executive Officer. 
K\RL M. Bowman, M.D., Chief Medical Officer. 
G. Philip Grabfield, M.D., Senior Physician. 
Riley H. Guthrie, M.D., Senior Physician. 
Oscar J. Raeder, M.D., Senior Physician. 
Harry A. Schneider, M.D., Senior Physician. 
Harry C. Solomon, M.D., Senior Physician. 
Jackson M. Thomas, M.D., Senior Physician. 
Teresa Acree, M.D., Assistant Physician. 
Lauretta Bender, M.D., Assistant Physician. 
Gaylord p. Coon, M.D., Assistant Physician. 
Mary Palmer, M.D., Assistant Physician. 
Charles B. Sullivan, M.D., Assistant Physician. 
Helen C. Coyle, M.D., Medical Interne. 
Leo H. Freedman, M.D., Medical Interne. 
Arnold W. Hackfield, M.D., Medical Interne. 
Douglas Noble, M.D., Medical Interne. 
S. C. RoTii, M.D., Medical Interne. 

■ — ., Chief of Neuropathological Laboratory. 

Marjorie Fulstow, M.D., Acting Chief of Neuropathological Laboratory. 
Whitman K. Coffin, M.D., Roentgenologist. 
Peter J. Dalton, D.M.D., Dentist. 

F. L. Wells, Ph.D., Head Psychologist. 

Mary Fitzgerald, Principal of School of Nursing. 

Esther C. Cook, Head Social Worker. 

Ethelw^n F. Humphrey, Head Occupational Therapist. 

Mrs. Elvf.retta Blake, Librarian. 

Elizabeth Libber, Treasurer. 

' By arrangement with the Department of Mental DiecaaeB. 



CONTENTS. 
Report of Trusteesv ..... 

Report of Director ..... 

Report of Chief Medical Officer 
Report of Out-Patieiit Department 
Report of Biochemical Laboratory 
Report of Psychological Laboratory 
Report of Neuropathological Laboratory 
Report of Department of Therapeutic Research 
Report of Chief Executive Officer . 
Report of Social Service Department 
Report of Superintendent of Nurses 
Report of Department of Occupational Therapy 
Publications ...... 

Report of Treasurer ..... 

Statistical Tables (Committed and Voluntary Patients) 



page 
3 
3 
12 
15 
21 
22 
24 
25 
27 
27 
30 
31 
33 
34 
35 



p. n. 137 3 
REPORT OF THE TRUSTEES 
BOSTON PSYCHOPATHIC HOSPITAL. 

To His Excellency the Governor, mid the Honorable Council: 

This annual report gives some indication of the stjiind methods and s<jund 
achievement which, we feel certiiin from our regular visiting contacts, are repre- 
sentative of the work in our impijrtant hospital. Xot only the Director's report 
but also the departmentiil reports are deeply informing about what is being ac- 
complished. We commend them all to- the reader. 

The Director does well again and again to call attention to the many relation- 
ships of the hospital — Uj family life and to other social institutions. Mental 
abnormality has implications for the various groups and agencies in society — 
familial, etlucational, vocational, welfare, police, legal, etc. — far beyond the 
meaning of physical disease. Many evidences of this are constantly cropping up, 
and we are happy to say that the whole hospital staff is alive to the facts. The 
Director tells of social pressures and tensions being taken into account in their 
bearing on the production of unbalanced mental stiites and, contrariwise, his and 
the other reports are shot through with connotations of what there is to be done 
in aiding solution of the problems that mental disorder brings to family life, to 
courts, to schools, to welfare workers. The service of the hospital extends far 
beyond its work with the patient himself. 

We would draw attention to the competency of the staff which is regularly 
attracted to the hospital by its reputation. And we regard as most remarkable 
the efficiency with which one executive officer after another, entering other parts 
of the state .service, has paved the way for his success<jr. The training methods 
of the Commi.ssioner of Mental Diseases work well. 

We are most happy that the long-desired improved X-ray apparatus is being 
installed. Our present look into the future is largely concerned with the develoi> 
ment of a program which will take into account the obvious difficulties arising 
from the stmctural arrangement and occasional overcrowding of those portions 
of the hospital where the more disturbed patients are cared for. 

Respectfully -nbinittod, 

William Healy, Chairman. C. I. Felch. 

Esther M. Andrews, Secretary. Channixg Frothingham. 

All.\x Winter Rowe. Charles F. Rowley 
WiLUAM J. Sullivan. 



DIRECTOR'S REPORT. 

DELE.\lbhlC io. I'.'JS. 

To the BiKird of Trustees of the Boston Psychopathic Hospital: 

In accordance with the provision of the statutes I submit for your considera- 
tion the report for the statistical year ending September 30. 1!>.?^. im<I f.-r f!i«' fiscal 
year ending November 30, 1928. 

On the Nature of the Annual Rki'out. 
An annual report is a document of a rather si)ecial nature. A- ,i ^luimiMrv of 
activities covering a sjKM'ial field, reijuiring fixed appropriations, 
material and |K?rsonal e<iuipment, it is a record of work done, a 1 
for the resource's placed at one's dis|)osal. An anrnial reixirt is obviously iu)t a 
place for a detailed discu.ssion of U'clmical me<iical proltlfm-^ <\\r]\ -i- would bo a|>- 



propriate for a me<li<'al journal. .\t the same time it ^< ;H)rt 
U) give the lay readi'r some insight into the nature of hos- 
pital and to help him to visualizr the concrete* hnndi' i;> ^ in the 
iiv(v of individual men and womi-n which bririL' fli'-m hospital 
for help. A report which merely coven^I tl re<I in a 
general way to the techni<*al activities of th* , 'W th;»t 



various activities were being carrit^l on with a certain 
expen.»<e under careful economic control, and would Hutisf> 



4 P.D. 137 

might fail to do justice to the occasion if it did not clothe the statistical figures 
with some human facts. The annual report is a public document and it may be 
expected to present to the community something of the social values represented ' 
in the work of the hospital as well as the bare economic and statistical data. Un- 
less the pubhc in general knows something of the nature of the work done in this 
specialized medical field, s\Tnpathizes with it and indorses the values embodied in 
it, the work will fail to receive the increasing support which it requires and will 
remain isolated and comparatively sterile. 

Ox THE Problems Presented by the Study .^'d Care of Patients. 
In the light of the above considerations an endeavor is made in each annual 
report to furnish illustrative examples of the problems dealt with at the hospital 
and thus give some body to the tables of statistics which are appended to the 
report. These examples may render more intelligible the role which the hospital 
plays in relation to the health of the community and indicate the bearing of this 
work on important problems of the family, the school, the court, the store and 
the workshop. 

A. B., a lad of 19. The patient had been fretting over his failure to make good 
in his occupation; in his emotional preoccupation over the question of his own 
personal value he seemed to get a religious revelation and saw in the clouds the 
faces of the great heroes of American history. A careful physical examination re- 
vealed nothing to throw any light upon this special experience. In the fight of 
a searching re\'iew of the patient's special temperament and past experiences the 
s\Tnptoms became at least partly intelligible as the reaction of a lad of special 
sensitiveness to the actual environmental stresses of his life. 

C. D., a man of 54, was dominated by the behef that his vriie was unfaithful; 
for this there seemed to be no foundation. This ca.se was not, as in many other 
cases, associated with alcoholism. The analysis of a delusion of this type takes 
one deeply into the personality of the indiv-idual and into the role which sex plays ^ 
in the life of the individual. 

E. F., a woman of 28, was transferred from a general hospital where she had 
been delivered of an illegitimate child. The patient was emotionally quite un- 
stable. The mental sjTnptoms were not typical of any definite mental disorder 
but were probably closely related to the tr\ing circumstances of her pregnancy, 
to her inability to establish the paternity of her child, to having to give up her J 
child, and to a phvsical disorder (phlebitis in one leg). The case illustrates the 
complexity of the causation in many of the cases. The type of reaction was no 
doubt largely determined by the patient's original constitution but the actual ; 
occurrence of the breakdown was no doubt the result of the long emotional strain 
and of the physical disorder. 

G. H., a lad of 18, was transferred from a general hospital because he had been , 
fasting as he identified himself with Jesus. His parents, as a matter of fact, re- 
fused to see anything abnormal about the patient and insisted on taking him home 
after one night in the hospital; the father was of ill-balanced mentality with a 
marked delusional tendency. 

I. J., a lad of 20, was sent from the court, where he had been taken on account 
of some brawl. For some years his behaviour had been somewhat unsatisfactory. 
The observation of the patient in the hospital showed that the conduct which had 
disturbed his family was due to a serious underlying mental disorder, which was 
related to deep-seated conflicts within himself. 

K. L., a man of 31, was referred from another hospital. He had been an indi- 
vidual difficult to get along with for many years; recently he had felt that he was 
accused of sex perversions, and thought that people talked about him. The 
patient had been working until two months before admission but had moved from 
one industry' to another; he represents one of the unstable industrial units which 
contribute to the problem of labor turnover. 

M. N., a man of 61, was a diabetic who had suffered from a stroke at 48; he 
had become childish and excitable and was admitted to the hospital because he 
had threatened his relatives. 

Mrs. 0. P., aged 28, since birth of her last baby had suffered from headache, 
sleeplessness, fear of suicide and fear of harming her children. Her physical con- 



P.D. 137 5 
dition necessitated a thorough X-ray study of the gastro-intestinal tract, which 
disclosed a duodenal ulcer; the otologist was consulted in regard to discharge 
from the ears. She left after nine days in the hospital. For the understanding 
of the fears of the patient the psychological approach was ob\iously essential. 

Q. R., a man of 32, three days after an operation in general hospital for osteo- 
myelitis, became delirious and was admitted to the Boston Psychopathic Hospital 
with, the wound still draining. The patient became clear after two days; his 
wound continued to require surgical attention. He was discharged eight days 
after admission. 

Mrs. S. T., aged 45, was admitted in a state of mild elation. For several years 
the patient had a large pelvic tumor, and on admission she showed some e\idence 
of th>Toid insufficiency. Although preoccupied with the tumor she refused to 
follow surgical ad\'ice; she had been following a great number of medical cults 
and fads until her admission to the hospital. 

Mrs. U. v., aged 54, had been using alcohol and drugs for an unknown period. 
In her irritation over a lawsuit she had made threatening remarks and was sent 
to the hospital for examination. In the hospital the withdrawal of the drug was 
accomplished with httle discomfort to the patient. She was later transferred to 
another hospital as she was too excited and unreasonable to be able to return to 
the community. 

These very brief histories of a few patients give some indication of the complex 
factors which are involved in the individual case and indicate the diverse lines of 
investigation which must be followed. The mental disorder in each case is studied 
as the complex reaction of an indi\ddual to environmental demands. The reaction 
of the individual is determined by the efficiency of the individual organs and sys- 
tems and by the constitution of the individual as modified by past experiences. 
The constitution is a general term which includes those elements of the person- 
ality, which are referred to as instincts and emotions, as well as less clearly out- 
lined patterns of reaction, which are part of the endowment of the indix-idual. To 
estimate the original constitution of the patient a careful review must be made of 
the stock from which he has sprung; the knowledge thus gained not only enables 
one to estimate more accurately the equipment of the individual for dealing with 
life and the special lines of sensitiveness for which allowance has to be made, it 
also furnishes valuable material in regard to the general problem of heredity. The 
subject of heredity is not only extremely complicated but one of very great prac- 
tical importance to society. With regard to this topic there is much looseness of 
thought, and data of doubtful value are often used to support dubious conclusions 
to which may be given practical effect. Accurate data in regard to the family 
history of patients suffering from mental disorders are, therefore, of considerable 
importance; in this way one sees how accurate investigation of the individual ca-^e 
in the interest of the individual patient furnishes valuable material for purpose-; 
of research. Research is not necessarily a special activity carried on detache I 
from the clinical investigation of the individual case, but is rather an attitude of 
mind and a method of working which is as valid in the ward as in the laboratory. 

The original constitution of the individual is modified by life's experiences, and 
the way in which the patient has been rendered more or less \'Tjlnerable to the 
stresses of life by the influence of the home, the school, the social environment has 
to be traced. The knowledge of the special factors which may have made the 
patient unduly sensitive to various issues of life is often essential in order to re- 
duce the sensitiveness of the patient and to help him to build up a greater degree 
of resistance. Here, too, as with regard to the analysis of the family history, the 
accumulation of material makes a valuable contribution to important topics of 
research. It throws light on the suljtle factors which penneate the atmosphere 
of the home and of the school; it makes clearer the special factors which determine 
the relations of the individual to the family circle, to fellow workers, to those of 
the other sex. Education has much to learn from the material thus made avail- 
able and it will be of great advantage to the mental hygiene of the community 
when the general results of studies of this nature arc familiar to teachers and 
parents. 

It was stated above that the mental disorder of the patient is studied a>< the 

rcnctioii of the individual tn tlic <Mi\ in»iirn('iit : it i< important to n\ilize that the 



6 ' P.D. 137 

efficiency of the total organism is dependent upon the efficiency of the component j 
organs and sj^stems and that the environment is not merely a question of the social 
environment but is also one which contains various detrimental germs and other | 
bodily risks for the individual. A patient may have come to the Boston Psycho- 
pathic Hospital on account of a change of mood, of friction with the group, of odd ' 
experiences which perplex those around him, while the underlying disturbance may 
be due to the simple bodily machinery being disturbed. The primary source of 
the disturbance may be in the central nervous system or it may lie in some other 
organ or system, the disturbed working of which interferes with the nutritional 
demands of the central nervous system. 

Failure of the heart, respiratory disorders, poor functioning of the kidneys, \ 
anemia of one or other type, disturbances in the gastro-intestinal system, anomalies 1 
in the secretion of the important endocrine glands (thyroid, pituitary, etc.) may 
so disturb the action of the central nervous system that the emotional life of the 
individual is no longer the same, his general grasp of the outside world undergoes 
distortion and his behaviour no longer meets the needs of ordinary social life. ' 
The central nerv^ous system itself may be the seat of structural damage; a severe 
head injury, causing concussion of the brain, may leave the individual a changed 
person; intracranial tumor m&y manifest itseh by immoral behaviour; inflamma- 
tory^ processes and vascular disease within the brain may give rise to varied forms 
of mental disorder. 

The examination of a mental patient, therefore, is not merely a question of ask- 
ing the patient about those changes in mood or attitude towards life which have 
been in the centre of the clinical picture, it is a question of studying all the factors 
which make up the complex organization of the individual. It is necessary to 
study the simple systems and organs in the same way as those of a patient in a 
general hospital. It is necessary, therefore, to have the same facilities as in the 
general hospital for making delicate tests, chemical and microscopical, of the 
various fluids of the body and for supplementing the thorough bed-side examination 
of the physical condition of the patient with other tests which can only be carried 
out in suitably equipped laboratories. The gastro-intestinal tract cannot be studied 
without adequate X-ray facilities. The efficiency of the thjroid and the pituitary 
glands can onlj^ be tested by methods which involve careful chemical analysis. 
Several of the conditions which do damage to the brain cannot be adequately fol- 
lowed without careful study of the cellular content and chemical constitution of 
the cerebro-spinal fluid in ^:hich the central nervous system is bathed. Even in 
the few cases referred to above one finds reference to a variety of phj^sical dis- 
orders — phlebitis, diabetes, cerebral softening, duodenal ulcer, middle-ear disease, 
osteomyelitis, pelvic tumor. 

The same problems which are presented by patients who are in the hospital have 
to be dealt with in the Out-Patient Department. Here, too, the dual aspect of 
the work msiy be emphasized, for while the individual patient is examined and 
treated, at the same time the obser^^ations made on the patient furnish an extremely 
important material for research. The social aspect of psychiatry, which becomes 
so apparent during the study of any group of mental disorders, is still more strik- 
ing when one considers the out-patient material, a large percentage of which con- 
sists of children under the age of 16. Children are brought for examination and 
for advice on account of a great variety of circumstances. A child may be brought 
on account of being finicky about food, on account of bed-wetting, of speech defect, 
or of dishonesty. It is hoped that, through the early recognition of problems in 
relation to conduct, the seeds of later mental disorder may be eradicated and the 
child may get help at a time when he is plastic and before habits get too deeply 
ingrained. 

On Research into the Causes of Mental Disorders. 
The remarks made above have indicated the point of view prevalent in the hos- 
pital with regard to problems of research. Research is considered not as a special- 
ized activity to be relegated to a special department, but represents an attitude of 
mind in the absence of which clinical work is apt to descend to a somewhat routine 
and perfunctory level, although in many cases it may not do so owing to the strong 
humanitarian and therapeutic interests of the physician. A keen interest in the 
many unsolved problems of psychiatry will make the study of each individual case 



P.D. 137 7 

much more pointed and efficient than it would be had the physician no interest in 
research and no determination to make his contribution to our knowledge of this 
obscure field. The spirit of research in the hospital during the past year has been 
fostered by the continuation of the statistical investigation of certain problems in 
this field, carried on in collaboration A^ath the Department of Vital Statistics 
of the Harvard School of Public Health during the past three years. The statisti- 
cal elaboration of case records has raised the problem of the adequacy of these 
records, has brought up questions of formulation and of methods which have been 
of distinct benefit to the clinical work. At the end of the three years during which 
the research has been carried on not only has material been systematized in the 
way in which it must be for statistical elaboration, but the issues involved have 
been becoming clearer and the constant discussion has been of use in suggesting 
specific topics for further investigation. In such an atmosphere the junior mem- 
bers of the staff have had an unusually good opportunity of coming to grips with 
some of the most important issues in psychiatry. 

In the reports of the various laboratories one finds more detailed reference to 
specific studies which have been carried on by different workers. 

Dr. Fulstow, who has continued to be acting chief of the neuropathological 
laboratory, in her report summarizes the result of her work in the laboratory; 
through painstaking research along these lines much light has been thrown upon 
mental disorders especially those associated with inflammatory and degenerative 
conditions. It is to be regretted that in this community there should be so much 
difficulty in obtaining permission \vith regard to the necessary post-mortem ex- 
aminations. The situation is very different in many institutions abroad where 
such an examination is looked upon as a regular procedure, where the cooperation 
of the laity with the medical profession in the interests of the health of the com- 
munity is fully established. 

Research into the underlying bodilj'' processes in cases of mental disorders has 
been carried on as diligently as possible with the faciUties at the disposal of the 
hospital. In the past few years Dr. Bowman and other workers have, in a series 
of communications, published the results of their studies on the subtle bodily 
changes which are elements in emotional states. In addition to this. Dr. Bowman 
has reviewed with unusual care the bodily changes in schizophrenia, the somewhat 
heterogeneous group of disorders which has been the main research topic of the 
staff for some time. The low level at which the vital processes seem to be carried 
on, as indicated by what is called a low metabolism rate, did not seem to be de- 
pendent upon an inadequacy of the thyroid gland. 

Dr. Grabfield, in his report from the biochemical laboratory, makes reference 
to the special investigations which he has undertaken into this problem of a low 
metabolism rate, and allied questions. As one analyzes the surface symptoms of 
disease and tries to penetrate to the underlying mechanisms one comes down to 
problems dealing with the fundamental life processes; investigations in this sphere 
take the worker away for the time from any immediate reference to the actual 
clinical material where the problems have had their origin. If satisfactory prog- 
ress is to be made in the study of mental disorders it is important that there should 
be an adequate provision for such fundamental studies on a generous scale. It 
may be objected that these fundamental studies, requiring a very special material 
and personal equipment, should be relegated to large departments of biochemistry. 
As a matter of fact, the workers in these latter laboratories are likely to be com- 
pletely occupied with problems which have arisen in a somewhat different setting. 
They are not, as a rule, free to take up the special problems presented in the psy- 
chiatric field, and there seems to be no sound reason why psychiatry should not 
follow the problems raised in its own special field of work as far as is possible, with 
an equipment which it strives continually to make more adeciuate for its own 
purpose. In this way psychiatry may make incidentally its contribution to the 
general fund of biochemical knowledge, just as in previous decades it was the 
most fertile contributor to the anatomy of the brain, l)()th gross and microscopic. 

Mrs. A. G. Sanborn, during the past two years, has been at work on the gastro- 
intestinal flora and has accumulated material which promises to give results of 
some interest. She is at present working on the elaboration of this material and 
on the preparation of her results for pul)lication, and this material should be avail- 



8 P.D. 137 

able in the course of the coming year. Whether further investigations along this 
line shall be continued will partly depend upon the availability of further funds. 
The research was carried on through the generosity of two private donors, in addi- 
tion to special grants from the Hai-vard Medical School. 

Dr. Solomon has continued his work, which is specially concentrated on the 
study and treatment of neurosyphilitic disorders, and in his report he gives an 
outline of the special problems which he has attacked during the past year. One 
of the great contributions which Dr. Solomon has made is the continuation of the 
treatment of neurosyphilitic patients for more than ten years, and in preserving 
the cooperation of individuals over this long period, and in thus maintaining them 
in normal working relationship with the community he has done a remarkable 
piece of work. Quite apart from this important contribution to our knowledge of 
therapeutics, Dr. Solomon has continued to investigate patiently the intimate 
mechanisms of the changes which are involved in the nutrition of the brain and 
in the composition of the fluid which surrounds it, researches which may not seem 
to have, at the moment, immediate practical application but which are of the type 
which furnishes the only sound basis upon which true scientific progress is made. 

Dr. Wells in his succinct report of the activities of the psychological laboratory 
has compressed into brief space an account of an extremely active and fruitful 
3^ear. The workers in the psychological laboratory not only are of great value in 
dealing with the continuing demand for psychometric estimates but have taken 
up under the direction of Dr. Wells systematic and fundamental analysis of many 
problems connected with mental tests, which have an important practical bearing. 
Mental tests have come to play a somewhat large role in relation to education and 
to industrial adaptation and a movement which has so much momentum is apt 
to be somewhat dangerous unless supervised and carefully controlled by sound 
scientific standards. It is gratifying to know that the work of Dr. Wells is looked 
upon as authoritative and that it is a serious contribution to the sane utilization 
of psychometric and vocational tests. 

On the Social Service Department. 
In referring to the general work of the hospital emphasis has been laid upon 
the point of view which considers each mental disorder as a problem of the adapta- 
tion of the individual to the tests imposed by the environment. In some cases, 
where there is some definite phj^sical disorder, the general social environment is 
unimportant although even here an environmental stress may have elicited a 
latent weakness and contributed to the actual mental disorder. In the ordinary 
organic disorder, however, the social stress and strain play a comparatively small 
role and the investigation and treatment of the case may not call for any special 
investigation of the environment. In a case of brain tumor, of delirium after 
childbirth, of hypothyroidism, the problem may frequently be dealt with ade- 
quately even though one treats the patient as a more or less isolated unit. In a 
great number of cases, however, the mental disorder may be totally unintelligible 
unless one considers carefully and in detail the stress involved in the environment, 
past and present. It may then be important to review very carefully the actual 
situation in the home, in the workshop or in the school, and the problem may be 
to see how an individual of a certain vulnerability, under the stress of a certain 
special life situation, came to react in the way which is characterized as a mental 
disorder. To some this seems an unprofitable line of investigation. They make 
the general assumption that mental diseases, having this term "disease" must 
necessarily be explained in the same way in which one explains a physical disease 
such as typhoid fever. They assume that a mental disease may have a certain 
independent existence within the individual and that the nature of the individual 
and of the situation is more or less irrelevant to the presence of the "disease." 
They consider that the only scientific method of approach, therefore, is to study 
the patient by the same methods by which one studies infectious diseases, disorders 
of nutrition, degenerative diseases. They may scorn an investigation into the 
actual life situation of the patient and into his past experiences as representing a 
"janitor's psychology." The detailed study of the actual evolution of many cases 
of mental disorder, however, seems to indicate that the environmental factors, 
the actual life situation, are not irrelevant to the development of the disorder, that 
they have to be reckoned with as one of the real causes and that in neglecting to 



P.D. 137 9 

pay attention to them the physician may miss the key to the whole situation. 
While it is true that in many cases a mental disorder is sjnnptomatic of some under- 
Ijang physical ailment, the physician must be on his guard against assuming that 
this is a foraiula to be applied to every case. The physician has to remember 
that the categories of internal medicine, which provisionally discards any reference 
to the personality, may be inadequate to the stud}^ of mental disorders where the 
personalit}" plays a central role. 

The study of the environmental factors in the setting of which a mental disorder 
has developed may require an investigation which goes beyond the information 
given by the relatives who \isit the patient at the hospital. The investigation 
may require some contact with teachers, employers, colleagues or neighbors, and 
the physician is rarely in a position to make this investigation personally. This 
investigation falls upon the personnel of the Social Service Department and with- 
out help of this type the phj^sician may be seriously handicapped in the interpre- 
tation of his case. In order that the social service worker may make an investi- 
gation which is directed to the main issues, which interest the physician, the worker 
must be familiar ^^^th the general trend of the medical work and with the special 
problems under consideration. The coordination of the work of the social worker 
with that of the physician is favored hy the frequent staff conferences at the hos- 
pital in which physicians, social workers, psychologists, occupational therapists 
and nurses are all present and have an opportunity of contributing to the discus- 
sion of individual cases, while becoming familiar with the general principles of 
psychiatric diagnosis and treatment. The work of the Social Service Depart- 
ment is, however, not merely investigative, it has also its important therapeutic 
aspect. The handicapped or convalescent patient may be able to return to hfe 
in the community with some supervision and with some guidance of those in touch 
with the patient, while without some such aid a relapse might be liable to occur. 
In regard to the numerous children who are studied in the Out-Patient Depart- 
ment, the social worker is able to do a great deal to protect or stimulate the child 
by keeping in touch with the teacher and the home. As a liaison officer betw^een 
the medical profession with, its somewiiat technical language and rather rigid 
formulations and the general public with its haphazard and partly mediaeval atti- 
tude towards mental problems the social worker performs a very important role. 
Without her patient interpretation of the significance of psychiatric diagnosis and 
of the principles of treatment outlined much of the effort expended by the psychia- 
trist on the patient w^ould be fruitless. Emphasis has been laid upon the nature 
of the work of the social worker in relation to the study and treatment of the in- 
dividual ca.se. From the point of view of research one might emphasize the fact 
that there is no body of .social material more valuable in its totality than the ma- 
terial collected by social w^orkers in the course of these intensive individual investi- 
gations. The material collected is of very great value for those wiio are interested 
in the study of the child, in the structure of the home, in the management of the 
sex instincts, in the sanctions of marriage, in recreational and cultural opportuni- 
ties. In connection with the special investigative work being done at the hospi- 
tal on the central problem of the schizophrenic conditions, it is expected that the 
material supplied by social service workers will be an important contribution. 
On the Nursing and Occupation.\l Activities of the Hospital. 

To the staff of the hospital it is a source of gratification to observe the intere-;t 
shown by the nursing and occupational personnel in their respective activities. 

There is, perhaps, no more arduous service in the nursing profession than tliat 
of caring for mental patients nor is there one wiiich makes s() many demands 
upon the intelligence, the sympathy and the patience of tlie nurse. At the same 
time there is no nursing ta.sk which makes a deeper appeal to tlie human iiiterests 
of the nur.se or which gives a more fa.scinating insight into human personality and 
the deeper issues of life. A few mirses may be temperamentally insensitive to 
some of these issues and may find a greater .satisfaction in manipulative activities 
or in administrative or executive |)ositi()ns. It is gratifying, liowever, t;) observe 
how much interest is shown bv the stream of affiliated mu'ses who ome to the 
Psychopathic lio.spital for a three montiis' period of training in this l)r:inch of 
nursing. The experience of the .second year with this system of affiliation has 
confirmed the good impression made by the nurses in the first year. An affiliation 



10 P.D. 137 

of this nature not only may lead a few more nurses to enter this special field of 
activity, but what is more important it will help to give the general body of nurses 
a correct attitude towards mental disorders and towards the personal issues even 
in patients suffering from the general run of somatic diseases, and a nursing body 
educated in these principles will have a profound influence upon the general thought 
of the community in regard to these matters. 

The influence of the nurse in the community may be illustrated by an apparently 
trifling incident. A mother brought her child to the Out-Patient Department for 
advice with regard to a minor disorder of behaviour. She did so although her 
husband had a prejudice against a ''mental" hospital and although she had been 
told by an academic lecturer of some distinction not to bring the child to the hos- 
pital because the child would always have the ''stigma" attached to such an ex- 
perience. When asked why she had brought the child to the hospital notwith- 
standing these influences she said that the district nurse, who had been giving her 
prenatal care, had recommended her to bring the child and she had complete con- 
fidence in the advice of the district nurse. With a community having this confi- 
dence in the nursing profession the latter evidently has the possibility of being 
one of the most powerful agencies in helping the community to get away from 
outworn and distorted theories of mental disorders. In Boston the situation is 
particularly satisfactory in regard to the extensive and efficient education of the 
community, for the great district nursing organization, the Community Health 
Association, is inspired by a most enlightened attitude tow^ards these problems. 
During the past year there has been close contact between our Social Service De- 
partment and the Community Health Association, and there have been frequent 
conferences in order to determine the principles of organization and the lines of 
future development as well as in order to deal with individual cases. 

Notwithstanding the somewhat limited accommodations at the hospital and the 
absence of adequate opportunity for outdoor occupations, through the skilled 
direction of Miss Humphrey, the maximum opportunity for occupational activity 
is furnished to the patients. In several communications Miss Humphrey has 
emphasized the general principles directing the work, the special conditions which 
the nature of the hospital furnishes, the relationship of the work to the general 
needs of the hospital, the realization by the individual patients of the immediate 
practical utility of the work in which they are engaged. 

Notwithstanding the interest of the nursing personnel and the activity in the 
Occupational Department, there are periods in the day's program when certain 
patients have had nothing to do and practically nothing to interest them, and 
such periods of enforced idleness must be considered detrimental to the patients. 
It is, therefore, a very great advantage to have at last installed in the various 
wards loud-speakers so that these serious gaps in the daily program may be filled 
by something other than subjective phantasies and morbid ruminations. 

On the Hospital as a Teaching Centre. 
The main function of the hospital is the care and treatment of the mentally 
sick and the investigation of the causes of mental disorders, with a view to their 
prevention and better treatment. At the same time the hospital serves as a train- 
ing centre where workers of many types can be prepared for their special activities 
in this field. 

The facihties of the hospital are available for the instruction of medical student- 
in this branch of medicine, and even though in the brief courses available a medical 
student cannot be expected to get an adequate grasp of the topic, he can at lea^t 
get the opportunity of seeing that mental disorders can be studied and treated on 
the basis of the same general principles which he is accustomed to apply in other 
branches of medicine. 

The staff of the hospital is being continually recruited from recent graduates, 
some of whom may not intend to make psychiatry their career but who wish, for 
one reason or other, to have a first-hand acquaintance with the field of mental 
disorders. In addition to the members of the staff there is attached to the hos- 
pital as a rule a group of volunteer workers who come from other institutions for 
varying periods in order to carry on graduate studies in this branch of medicine. 
The graduate worker is not given systematic instruction but works with the mem- 
bers of the staff as a colleague, and in thus sharing in the clinical work with its 



P.D. 137 11 

accompanying discussions and conferences he makes a contribution to the hospital, 
while at the same time he is becoming familiar with the point of view of the other 
members of the staff and getting suggestions with regard to special reading, and 
lines of special investigation. 

In the psychological department systematic instruction is given to accredited 
students and where workers from other hospitals in the state require special train- 
ing in psychometric methods and standards a special effort is always made to 
accommodate them. 

In the other departments of activity which have been referred to, in the nursing, 
occupational and social service departments, teaching is considered to be an im- 
portant function as well as treatment and research. 

On the Out-Patient Department. 
In October, 1927, Dr. Taylor resigned from the position of Chief of the Out- 
Patient Department and Dr. 0. J. Raeder was appointed to this position in Janu- 
ary, 1928. 

In the general work of the hospital the Out-Patient Department continues to 
play the same important role. It is partly the door by which many patients come 
into the hospital but its still more important function is to supply guidance and 
help to those who are still able to carry on outside and who, without the help of 
such consultation, would either be undergoing unnecessary distress or who would 
have to give up altogether. It is chiefly through the Out-Patient Department 
that the hospital keeps in touch wdth the problems of childhood and a constant 
stream of children is brought to the Out-Patient Department for advice with re- 
gard to the problems involved in child management. A glance at the problems 
presented by the patients in the Out-Patient Department as summarized in the 
report of Dr. Raeder gives some slight idea of the breadth of the field of mental 
disorders. In view of the fact that the material presented by out-patients is some- 
what different in type from that presented by the patients in the hospital, each 
member of the staff spends some time in the Out-Patient Department so that he 
may become familiar with the general extent of the problems in this field of medi- 
cine and not concentrate too exclusively upon cases of such a serious nature that 
they have to be admitted to the hospital. 

The psychological department has taken special interest in some selected out- 
patient problems. Not only have the psychologists continued to maintain their 
psychometric work at a rather unusual level of excellence, but they have taken up 
the problems of non-reading children and have made a special investigation of 
their difficulties. 

Dr. Kibble, a Commonwealth Fellow in Psychiatry, has taken up specially the 
psychopathology of childhood and is concentrating on the investigation of certain 
quite specific topics. 

Informal conferences in the Out-Patient Department, which are often attended 
by the social workers or teachers or other workers who happen to accompany 
patients, have been continued during the past year as they serve a useful purpose 
and help to prevent too strict a separation of the work of the Out-Patient Depart- 
ment from the general work of the hospital. 

The school survey in the town of BrookUne was carried through in the past 
year as in previous years and the far-seeing meaure of the systematic review of all 
children seriously retarded in their class- work has now come to be a familiar ex- 
perience to the teachers and will soon be looked upon by. the community as a recog- 
nized and essential part of the general educational machinery. There is always 
some danger that an enlightened measure of this nature may arouse ill-founded 
suspicion or antagonism and it is satisfactory to report that the attitude of the 
community towards the carrying out of the sclioni -nr\ (>\' i< oik^ of -vtnn:it!i<'tic 
cooperation. 

On the General Administration of thi: Uo.^i'h al. 
The review of the activities of the various departments may have given soine 
indication of the necessity for constant coordination. It is on tlie Chief Executive 
Officer that the responsibility for this co()rdination devolves. Not only has he 
to supervise carefully the finances of the hosjiital, look after all supi)lies, see that 
vacancies in the nursing personnel and in the iiousehold staff are filled, he h!U< also 



12 



P.D. 137 



the direct supenision of the coordination of the medical, nursing and ancillary 
ser^'ices and has, vdth his assistants, to superA'ise all the technical requirements 
regulating the admission of patients to the hospital and to deal with relatives in 
all the questions which arise in coimection \\dth their interest in the course and 
treatment of a mental disorder. 

In spite of this somewhat compUcated program with its varied interests and 
acti^-ities. it has been possible for a new Chief Executive Officer to adapt himself 
to the situation with remarkable speed and efficiency. Within the last twelve 
months there have been three Chief Executive Officers, Dr. Bonner lea^'ing the 
hospital in December, 1927, after a successful administration of three years, Dr. 
Dexter being appointed in January and after ten strenuous months iea^dng t > 
become superintendent of the Foxboro State Hospital. Dr. Arthur X. Ball wa- 
appointed on October 29, 1928, and, although at the hospital for only five weeks, 
presents in his report a rcAdew of the executive work. The smoothness of the 
running of the hospital, the standards of medical and nursing care, the freedom of 
the clinical workers from distracting demands, all depend upon the efficiency of 
the executive staff, and it is a pleasure to acknowledge the excellent ser^-ice which 
the executive staff has consistently rendered. 

During the past year, as in previous years, the atmosphere of the hospital has 
been one of busy medical activity with a staff seriously interested in this special 
medical field and working with healthy investigative interests and not merely in 
a routine manner. 

The Board of Trustees has throughout the year maintained its customary close 
contact vdth. the work of the hospital, and has always been ready to offer construc- 
tive criticism and to discuss problems of detail and of general policy. 

The Director wishes to express his appreciation and that of the staff to Dr. 
Kline, Commissioner of >Mental Diseases, for his readiness to take up promptly 
and s\TnpatheticaUy the problems brought before him and for offering helpful 
counsel and smoothing out many difficulties. 

Respectfully submitted, 

C. MACFIE CAMPBELL, Director. 

REPORT OF THE CHIEF MEDICAL OFFICER. 
To the Director of the Boston Psychopathic Hospital: 

The exact organization 'and functioning of the medical service of a hospital of 
this kind is confusing to many people. The resident medical staff is composed 
largely of recent graduates, who are anxious to secure training in psychiatrj^, either 
to specialize in that field, or to obtain knowledge useful in other branches of medi- 
cine. The appointments are for a period of one year, but a physician may be re- 
appointed at the end of the j^ear if this is desirable. The regular resident medical 
staff is composed of eight physicians. In addition to this there are a number of 
volunteer workers. 

The average admission rate of the hospital is five patients per da3^ As the 
majority of these cases are sent in for a ten-day period of obserA'ation, the case 
must be studied intensively during the first few days in hospital. This means a 
careful physical and neurological examination, a thorough history and a mental 
status. In addition to this such laboratory tests as are indicated must be done. 
The X-ray report shows that 669 patients admitted during the year were given 
seme sort of X-ray examination. All the routine laboratorj^ tests, such as blood 
chemistr^^, basal metabolism, etc., are available if indicated. A lumbar puncture 
is done in a considerable number of cases as examination of the spinal fluid is 
frequently indicated. The Social Service Department may be requested to secure 
further details concerning the historj^ of the patient. The patient's condition i- 
then discussed at .ward rounds on the 4th or 5th day following his admission; 
diagnosis is made and recommendations as to further treatment are given. 

It may be pointed out that the criteria for diagnosis are somewhat uncertain, 
that the scheme of classification at present used is somewhat rigid and unsatis- 
factory and that while such classification is necessarj', the phj^sician's mind is not 
focused on classification as his main problem. Xot only must the patient be 
studied while in hospital and a diagnosis obtained, but he must receive treatment 



P.D. 137 13 
for his condition. A psychopathic hospital is equipped in a somewhat different 
manner from a general hospital. Nevertheless, it has all the problems of a general 
hospital to deal with. The patients who come in represent all types of physical 
disorders. Some of them have developed mental symptoms due to disease of the 
heart or kidneys, some are suffering from diabetes and require insulin treatment. 
The delirium of such infectious disease as pneumonia may require the patient to 
be cared for at this hospital. Following a surgical operation or childbirth, the 
patient may develop an acute mental state which requires care at this hospital. 
This means that the hospital must be prepared to deal with all of the problems 
with which the general hospital deals, besides its own specialty. 

The use of hydrotherapy and occupational therapy is probably more highly- 
developed in mental hospitals than in any other type of institution. The physi- 
cian must, therefore, be familiar with these two methods of treatment and be pre- 
pared to use them. 

In the treatment of general paresis, we have a special ward, where the newer 
methods of treatment such as malaria are employed. Each physician is assigned 
for one month to the department of therapeutic research of Dr. Solomon in which 
he receives training in the technique of lumbar punctures and various methods of 
treating syphilis. 

The smooth and efficient functioning of a medical staff under these conditions 
calls for careful organization and supervision. Problems are further complicated 
by the use of the hospital as a teaching center for medical students, psychologists, 
social workers, nurses and occupational therapists. 

Not only must the physician receive training in the routine care, diagnosis and 
treatment of mental disease, but he must be encouraged to study some of the fun- 
damental problems involved and to undertake some piece of research. During 
the past year particular emphasis has been laid on the study of schizophrenia, 
and different members of the staff have been encouraged to undertake studies of 
special groups of cases. Some of the problems studied are cases diagnosed schizo- 
phrenia, which do not show delusions or hallucinations, cases diagnosed schizo- 
phrenia which have low intelligence to begin with, cases diagnosed schizophrenia 
which show fantastical and elaborate delusional formations, etc. 



The report of the dentist follows : 

Patients examined ...... 1,808 

Patients receiving treatment .... 850 

Extractions 1,082 

Fillings 490 

Prophylaxis ....... 195 

Plates 4 

Other treatments 216 



X-ray studies of 120 cases show definite infection in 46 cases, doubtful infection 
in 14 cases, negative in 60 cases, impacted teeth in 18 cases, doubtful impaction 
in 7 cases, unerupted teeth in 11 cases, impacted 4th molars in 1 case. 

The new gas machine has assisted materially, enabling us to care for some pa- 
tients for whom dental treatment was previously considered impossible. 

The X-ray report for the year is given below: 

Males. Females. Total. 



December 35 13 48 

January ....... 33 18 51 

February 41 23 64 

March 44 33 77 

April 41 22 63 

May 37 29 66 

June 33 15 48 

July 39 34 73 

August 21 10 31 

September 25 9 34 

October 44 23 67 

November 28 19 47 



421 248 669 



14 P.D. 137 I 

At the time of this report our new X-ray machine, suppHed with current from : 
the Edison Electric Company, is being installed. Because of defects in the old 1 
machine, the number of X-rays taken, particularly during the latter part of the 
year, was considerably reduced. It was not possible to take good dental films 
with the X-ray tube available, and it was not felt desirable to spend further sums 
of money in adding to the equipment of the old machine when we were about to 
install a new one. It is expected that the coming year wiU see a marked increase 
in the number of X-rays taken. 

Ward A has again been used throughout the year by Dr. Solomon in carrying 
on his work of the therapy on general paresis. 

Ward B has been used for about eight months of the year in connection with 
various research studies which have been going on. The most important of these 
studies has been carried on by Dr. Sanborn with regard to the bacteriology of the 
gastro-intestinal tract in schizophrenia. 

During the past year we have been more fully staffed than at any time in the 
past. Not only has the regular staff been completely filled but we have been 
compelled to reject applications of volunteer workers, because of lack of accom- 
modations. 

With the increasing number of physicians working at the hospital and the added 
amount of research work going on, there is the constant problem of finding room 
for the large number of workers who are carrying on these important studies. 

We have reached the physical limits of the hospital and if additional work of 
research is to be done, it can only be done by increasing the size of the hospital. 

ICARL M. BOWMAN, Chief Medical Officer. 

RESIDENT STUDENTS. 

Dr. N. Joseph Berkwitz, a teaching fellow in nervous and mental diseases of the 
University of Minnesota, spent three months studying at the Boston Psychopathic 
Hospital. 

Dr. O'Gorman R. Lynch, assistant superintendent of the Ontario Hospital, 
Brockville, Ontario, Canada, spent two and one-half months studying at the 
Boston Psychopathic Hospital under a special arrangement with the Canadian 
National Committee for Mental Hygiene. 

Dr. Clifford D. Moore, of the Medfield State Hospital, spent one month study- 
ing at the Boston Psychopathic Hospital. 

Dr. Isabella M. Robertson, of London, England, spent five months studying at 
the Boston Psychopathic Hospital. 

Dr. John W. Field, of Kansas City, Missouri, spent two months studying at 
the Boston Psychopathic Hospital as a graduate student of the Harvard Medical 
School. 

Dr. Bettina Warburg, of New York City, spent five months studying at the 
Boston Psychopathic Hospital. 

Dr. Leopoldo Pardo, senior surgeon of the Philippine Health Service, spent six 
months studying at the Boston Psychopathic Hospital as a graduate student of 
the Harvard Medical School. 

Dr. Catalina Policarpio Pardo, senior surgeon of the Philippine Health Service, 
spent two months studying at the Boston Psychopathic Hospital as a graduate 
student of the Harvard Medical School. 

Dr. F. P. Manship, of Washington, D. C, spent three months studying at the 
Boston Psychopathic Hospital. 

Dr. Ira M. Altshuler, of Detroit, Michigan, spent one month studying at the 
Boston Psychopathic Hospital as a graduate student of the Harvard Medical 
School. 

Dr. E. D. Hatcher, of Carthage, Missouri, spent one month studying at the Bos- 
ton Psychopathic Hospital as a graduate student of the Harvard Medical School. 

Dr. Donald H. Linard, a fellow of the National Committee for Mental Hygiene, 
spent two months studying at the Boston Psychopathic Hospital. 

Dr. Andrew H. Woods, professor of psychiatry at the University of Iowa, and 
director of the Iowa Psychopathic Hospital, spent two months studying at the 
Boston Psychopathic Hospital. 



P.D. 137 



CHANGES IN STAFF. 



15 



A. Resignations. 

Dr. C. A. Bonner chief executive officer, resigned January 1, 1928. 

Dr. Roderick B. Dexter, chief executive officer, resigned October 29, 1928. 

Dr. O. Spurgeon EngHsh, medical interne, resigned June 1, 1928. 

Dr. Edwin F. Gildea, assistant physician, resigned March 1, 1928. 

Dr. Manfred Guttmacher, medical interne, resigned May 1, 1928. 

Dr. Meta F. Haldeman, assistant neuropathologist, resigned May 22, 1928. 

Dr. M. Ralph Kaufman, assistant physician, resigned September 1, 1928. 

Dr. Charles H. Kimberly, senior physician, resigned September 1, 1928. 

Dr. David Prial, assistant executive officer, resigned September 22, 1928. 

Dr. Margaretta A. Ribble, medical interne, resigned October 1, 1928. 

B. New Appointments and Promotions. 
Dr. Arthur N. Ball appointed chief executive officer October 29, 192S. 
Dr. Gaylord P. Coon appointed assistant physician September 1, 1928. 
Dr. Helen C. Coyle appointed medical interne September 15, 1928. 
Dr. Leo H. Freedman appointed medical interne September 1, 1928. 
Dr. Riley H. Guthrie appointed senior physician September 1, 1928. 
Dr. Arnold W. Hackfield appointed medical interne September 1, 1928. 
Dr. Douglas Noble appointed medical interne September 9, 1928. 
Dr. Oscar J. Raeder appointed senior physician January 2, 1928. 
Dr. S. C. Roth appointed medical interne January 25, 1928. 
Dr. Jackson M. Thomas appointed senior physician September 1, 1928. 



REPORT OF THE OUT-PATIENT DEPARTMENT. 
To the Director of the Boston Psychopathic Hospital: 

I herewith submit the annual report of the Out-Patient Department for the 
year ending November 30, 1928. 

The following is the list of the personnel with changes made during the year: 
Dr. Marianna Taylor resigned as Chief of the Out-Patient Department on October 
22, 1927, and has reported since on Tuesdays as a volunteer worker. She was 
succeeded on January 1, 1928, by Dr. Oscar J. Raeder, the present incumbent. 
Dr. Charles W. Stephenson, Assistant Physician, was appointed on October 11, 
1927, and resigned May 15, 1928. Dr. Mary Palmer was a daily volunteer worker 
from October 1, 1927, to July 2, 1928, when she was appointed Assistant Physician. 
Dr. Charles B. Sullivan, a member of the regular staff, attends on Tuesdays, 
Thursdays and Saturdays. Dr. Martin W. Peck has reported on Wednesdays. 
Dr.* Anna M. Skinner reported on Wednesdays and Saturdays from September, 
1927, to June, 1928. Dr. Henry B. Elkind reported on Wednesdays from Febni- 
ary, 1928, to April, 1928. Dr. Henry A. Shaw reported on Fridays throughout 
the year, with the exception of four summer months. Dr. Oliver Cope was a 
student worker in the clinic November and December, 1927. Dr. Rose C. Munro 
reported on Thursdays from April, 1928, to July, 1928. Dr. Margaretta Ribble 
took charge of the school clinic with the Brookline schools during the early part 
of the year, and has since October been doing special work as a Commonwealth 
Fellow in Psychiatry. 

We have felt the loss of Miss Suzie Lyons and of Miss Rising, who rosigiiod. 
The cooperation of their successors. Miss Esther C. Cook, Chief of Social Service, 
and Miss Villa T. West, Clinic Manager, with the medical staff, has been an im- 
portant factor in the success of the year's work. 

The increasing number of contacts with social agencies and the i)ul)lic in general 
has been responsible in a large part for the increase in the number of patients seen 
during the year, — about nine per cent increase over last year. 

The work of the clinic includes examination, treatment and advice given for all 
types of nervous and mental conditions arising in ohiUlren and adults. The work 
with conduct problems in school children has steadily increased and a great many 
pupils who have become conduct problems are referred by the superintendents 
and others of the personnel of the public school departments of the v:irioii«j com- 



16 



P.D. 137 



munities. We feel that this is one of the most valuable, most important functions 
of the clinic and of great value to the community. These children are carefully- 
studied, first from the physical and developmental standpoint, a careful psycho- 
metric examination is done by the psychologist, and then a psychiatric examination 
made, and ad\dce and a program for treatment given the referring agency. Many 
of these cases are followed in the clinic and seen repeatedly for special treatment. 
A great deal of valuable work in mental hygiene, with a view toward the preven- 
tion of more serious nervous and mental diseases in these children later on in life, 
is possible among these cases. 

The increase in the number of cases referred (see table) from almost every source 
seems to indicate that the community physicians in general, the courts and social 
agencies, schools and others, are finding the Out-Patient Clinic a valuable aid in 
handling their various psychiatric problems. It has been especially gratifying to 
discover various personality difficulties and defects in children referred by the 
courts. In this way it has been possible to give valuable advice which is always 
carefully considered by the courts in their decisions. In this way no doubt a 
considerable impetus is contributed to the prevention of crime throughout the 
community. 

This year Dr. Palmer, Assistant Physician in the Out-Patient Department, has 
charge of the school clinic work for retarded children in the Brookline District. 
To date, the examination is haK finished and sixty children have been examined. 
There are approximately sixty more to be seen. A complete report of the work, 
therefore, cannot be made at present. 

The usual preparations for these psychiatric examinations have been and are 
being carried out by a psychologist from the Psychological Department and the 
history and other social data are obtained by the social worker. The psychiatrist's 
opinion and advice, founded on her examination and other data, are furnished the 
Superintendent of Brookline Schools and the Department of Mental Diseases. 

In the general work of the Out-Patient Department there has been an excellent 
spirit of scientific interest and of cooperation between the various departments. 
The medical staff of the House have at all times given generously of their time to 
aid in the study of these patients. 

Staff meetings, presided over by the Director, have been a great stimulus to 
the work in general and to the psychiatric study of conduct disorders in adults and 
particularly in children. These conferences have also furnished a forum where 
questions of psychiatry and sociology have been brought up and discussed. 

In the following pages will be found statistical tables covering the patients ad- 
mitted to the clinic during the year. 

Respectfully submitted, 

OSCAR J. RAEDER, 
Chief of Out-Patient Department. 



Statistics of Out-Patient Department. 



October 1, 1927 — September 30, 1928. 



Total New Patients 






1,086 


Out-Patient Department 






98 


Syphilis Division 






100 


New Patients: 


Male. 


Female. 


Total. 


Adults 


191 


253 


444 


Adolescents ..... 


71 


105 


176 


Children 


213 


153 


366 




475 


511 


986 


Plus: 








Syphilis patients .... 


48 


52 


100 



Total 



523 



563 



1,086 



P.D. 137 



17 



Nationnlity. 

Male. Female. Total. 



African . . . . 


11 


15 


26 


American . . . . 


137 


161 


298 


Armenian . . . . 


— 


3 


3 


Austrian . . . . 


1 


2 


3 


Belgian . . . . 


- 


1 


1 


Canadian . . . . 


4 


7 


11 


English . . . . 


69 


60 


129 


Finnish . . . . 


2 


1 


3 


French . . . . 


9 


19 


28 


German . . . . 


4 


11 


15 


Greek . . . . 


3 


5 


8 


Irish . . . . 


100 


79 


179 


Italian . . . . 


58 


60 


118 


Jewish . . . . 


50 


48 


98 


Lithuanian 


6 


9 


15 


Pohsh . . . . 


5 


6 


11 


Portuguese 


1 


6 


7 


Scotch . . . . 


9 


3 


5 


Scandinavian 


1 


1 


2 


Spanish . . . . 


1 


1 


2 




7 




15 


Syrian . . . . 


. . . . 3 


5 


8 


West Indian 


1 




1 






475 


511 


986 




Occupation. 






At home . . . . 


69 


189 


258 


Attendant 


1 


— 


1 


Baker . . . . 


2 


— 


2 


Barber . . . . 


1 


— 


1 


Blacksmith 


1 


— 


1 


Carpenter 


7 




7 


Chauffeur . . . . 


2 


— 


2 


Chef . . . . 


2 


— 


2 


Church worker . 


— 


1 


1 


Clergyman 


1 


— 


1 


Contractor 


1 


— 


1 


Dietitian . . . . 


— 


1 


1 


Dish washer 


1 


~" 


1 


Domestic . . . . 


~ 


54 


54 


Draftsman 


2 


— 


2 


Electrician 


3 




3 


Engineer . . . . 


3 




3 


Factory worker . 


21 


19 


40 


Farmer . . . . 


2 




'> 


Fruit dealer 


2 






Garage worker . 


1 


~ 


1 


Gardener . . . . 


3 




3 


Hairdresser 


~ 


1 




Hotel work 


I 




} 


Insurance agent 


3 






Interior decorator 


1 






Iron worker 


I 






Janitor . . . . 


4 






Jeweller . . . . 


1 






Junk collector 


1 






Laboratory technician 


I 






Laborer . . . . 


'2\ 




21 



18 P.D. 137 

Male. Female. Total. 

Laundry work ....... 1 3 4 

Librarian ......... 1 1 

Machinist's helper ...... 1 - 1 

Mechanic 10 - 10 

Messenger 2 - 2 

Motorman ....... 1 - 1 

Musician ........ 1 1 2 

Nurse - 3 3 

Office work 15 22 37 

Painter 7 - 7 

Paper hanger ....... 1 - 1 

Piano teacher ........ 1 1 

Plumber ........ 1 - 1 

PoUceman 1 - 1 

Printer 1 - 1 

Radio operator 1 - 1 

Sailor 1 - 1 

Salesman ........ 10 - 10 

Saleswoman ........ 7 7 

Seamstress ........ 2 2 

Shipper ........ 4 - 4 

Social worker ....... 1 - 1 

Steamfitter 2 - 2 

Storekeeper ....... 1 - 1 

School-child 233 196 429 

Tailor ..5 - 5 

Teacher 2 3 5 

Teamster ........ 4 - 4 

Telephone operator - 3 3 

Theatrical work - 1 ' 1 

Upholsterer 2 - 2 

UtiUty man ....... 1 - 1 

Waiter 3 - 3 

Waitress - 3 3 

Watchman ....... 3 - 3 

Woodsman 1 - 1 

475 511 986 

Referred by 

Psychopathic Hospital 16 13 29 

Other hospitals ........ 99 84 183 

Physicians 89 81 170 

Schools 45 21 66 

Social agencies 125 242 367 

Clergymen ....... 2 1 3 

Courts 23 3 26 

Relatives and friends 52 39 91 

Own initiative 24 27 51 

475 511 986 



Problems. 

Advice in regard to child training, 1; after-care (Psychopathic Hospital), 40; 
alcohohsm, 3; conduct problem, 175; confusion, 7; court charge of assault of 
child, 1; court charge of nonsupport, 1; crawUng sensation, 1; day dreaming, 3; 
depression, 36; dislike of school, 2; dizziness, 2; domestic difficulties, 13; drug 
addiction, 1; emotional instability, 23; epilepsy, 6; exhaustion, 9; fainting, 1; 
fears, 11; forgetfulness, 7; glandular diiSiculty, 1; headaches, 14; hydrocephalus, 
1; "hypnotized", 1; hysteria, 1; ideas of persecution, 3; illegitimate pregnancy, 
25; insomnia, 13; irresponsibility, 9; irritability, 5; lack of self-confidence, 1; 



P.D. 137 



19 



lack of coordination, 1; larceny, 3; loneliness, 2; masturbation, 6; nervousness, 
67; "neurasthenia", 2; neurotic traits, 28; nightmares, 2; obsessive ideas, 3; 
odd behavior, 14; overactivity, 1; paresis (?), 2; personality problems, 3; "Psy- 
chasthenia," 1; "Psychoneurosis," 1; . 

On question of — Ability to work, 4; ability to care for children, 2; assault by 
father, 1; endocrine disorder, 2; mental rating, 190; post encephalitic condition, 
2; psychosis, 21. 

Reading difficulty, 5; refusal to eat, 1; retardation in school, 75; self conscious, 
sensitive, 3; sex problem, 14; shortness of breath, 1 ; "spells," 5; speech difficulty, 
20; suicidal, 5; somatic complaints, 15; traumatic neurosis, 1; trembling, 3; 
twitching, 6; vagrancy, 2; visions, 3; vocational guidance, 37: voices, 3; weak- 
ness, 1; worries, 11. Total, 986. 



Diagnosis. 

Senile psychosis 
Psychosis with arteriosclerosis 
General paresis . 
Juvenile paresis 
Chronic alcoholic psychosis 
Psychosis due to drugs and other exogenous poisons 

(lead) 

Drug addiction 

Psychosis with other somatic disturbance 
After-care, toxic psychosis . 
Puerperal psychosis .... 

Manic-depressive psychosis — Manic . 
Manic -depressive psychosis — Depressive 
Manic-depressive psychosis — Mixed 
Schizophrenic psychoses 
Paranoid condition .... 

Epilepsy ...... 

Psychoneurosis : 

Neurasthenic type .... 

Hysteria ..... 

Anxiety type ..... 

Obsessional type .... 

Compulsion neurosis 

Psychasthenic type 

Mixed type ..... 

Chronic invalidism .... 

Unclassified ..... 
Psychosis with psychopathic personality 
Psychopathic personality 
Psychosis with mental deficiency 
Undiagnosed psychosis 
Without psychosis — Unclassified 
Traumatic encephalopathy . 
Post encephalitic condition . 
Hemiplegia with deterioration 
Organic brain disease .... 
Question of organic condition 
Somatic disease: 

Cardiac 

Arthritis 
Arteriosclerosis . 
Congenital lues . 
Chorea 

Endocrine disorder 
Somnambulism . 
Acute veronal poisoning 



Male. 


Female. 


Total. 


- 


2 


2 


2 


3 


5 


4 


3 


7 


2 


- 


2 


6 


- 


6 


1 


— 


1 


2 


- 


2 


3 


5 


8 


- 


1 


1 


- 


1 


1 


1 


5 


6 


19 


41 


60 


— 


1 


1 


22 


21 


43 


8 


10 


18 


20 


8 


28 


10 


7 


17 


,5 


15 


20 


5 


5 


10 


2 


5 


7 


- 


2 


2 


1 


3 


4 


1 


- 


1 


1 


- 


1 


25 


7 


32 


- 


1 


1 


23 


28 


51 


1 




1 


15 


13 


28 




6 


() 


1 




I 


2 




2 




1 


1 


1 


1 


2 




1 


1 


1 




1 




1 


1 


1 




1 


I 




1 


•) 




2 




I 


I 


I 




I 


I 




1 



20 

Homosexuality . 

Non reader 

Neurotic child . 

Conduct disorder 

Speech defect . 

No nervous or mental disorder 

Average intelligence . 

Superior intelligence . 

Normal child 

Normal adult 

Mental deficiency 

Borderline intelligence 

Low normal intelligence 

Diagnosis deferred 



Disposition 
Psychopathic Out-Patient Department 
Psychopathic Hospital 
General Hospital 
Report to Social Agency 
Report to School 
Report to Court 
Institution for F. M., advised 
Commitment to State Hospital, advised 







P.D. 137 


Male. 


Female. 


Total. 


1 


- 


1 


5 


4 


9 


15 


15 


30 


54 


51 


105 


6 


1 


7 


2 


6 


8 


33 


34 


67 


9 


9 


18 


17 


14 


31 


3 


1 


4 


62 


94 


156 


22 


13 


35 








21 


24 


45 


475 


511 


986 


317 


298 


615 


59 


52 


111 


1 


1 


2 


52 


132 


184 


22 


2 


24 


9 


2 


11 


in 


17 


97 


5 


7 


12 


475 


511 


986 



Visits. 

Total visits 2,762 

New patient 1,448 

Out-Patient Department .... 1,348 
S3^hilis Division ..... 100 



Old patients 1,314 

Clinic days 302 

Average visits per day 9 

Visits per Visits per 

New patients: Month. Old patients: Month. 

1 .... 748 1 .... 677 

2 .... 175 2 .... 158 

3 .... 45 3 .... 55 

4 . . . . 5 4 .... 15 

5 . . . . 3 5 .... 14 

6 . . . . 3 6 . . . . 2 
7.... 5 7.... 2 
8 . . . . 1 9 . . . . 1 

18 ... . 1 



986 



924 



P.D. 137 



21 



REPORT OF BIO-CHEMICAL LABORATORY. 
To the Director of the Boston Psychopathic Hospital: 

I herewith submit my report for the year ending November 30, 1928. 

A number of changes have occurred in the organization of the laboratory which 
should be recorded. In June, 1927, funds became available for the study of 
chloride metabohsm in patients with fever. The Department of Therapeutic 
Research has patients in its ward under treatment with malaria, who of course 
present the opportunity for studying intermittent fever. It seemed appropriate 
that these patients be utilized to further work begun elsewhere. Mrs. Kubik 
(previously Miss Knapp) took over this work as her sole activity, under the joint 
direction of Dr. Solomon and Dr. Frank Fremont-Smith of the Boston City Hos- 
pital, who initiated these studies at that laboratory. In her place Miss Nancy 
Underbill has been appointed as Junior Chemist to cover the routine work of the 
hospital. 

Mrs. Kubik has completed the first phase of the study of the effects of high 
protein diets on patients with mental disease having a low basal metabolic rate. 
So far, these studies have shown no variation from the older findings under these 
conditions. Her work occupied itself with the addition of large amounts of egg 
albumen on the one hand, and of similar amounts of mixed protein on the other, 
to indi^'iduals previously on a constant diet. Again we are unable to demonstrate 
any other metabolic variation in these patients with low basal metabolism. It is 
planned to carry further studies already begun by Mr. (now Dr.) Davenport on 
the specific dynamic action of protein and carbohydrate in similar patients. Ex- 
periments so far concluded seem to indicate that in this direction also, psychiatric 
patients with low basal metabolic rates react normally from their level. These 
experiments merely consist in determining over a period of four hours the per- 
centage rise caused by the ingestion of given amounts of pure protein carbohy- 
drate or fat. Further studies to complete this series of observations \vill be carried 
out in the coming year though the results appear to be negative. 

We have further continued the estimation of blood cholesterol in the fasting 
state in these individuals with low basal metabolism. This blood constituent of 
the fatty series is of importance to the bodily economy in all probability in relation 
to certain vitamins. It has been stated in the past, that the figure tends to be 
high in patients with thyroid deficiency and low in Grave's disease. Indeed, the 
finding of a high blood cholesterol in nephrosis has stimulated Epstein to consider 
this disease as a thyroid deficiency. In the case of nephrosis also, it is associated 
with a low basal metabolic rate. It has all along been our contention that the 
low basal metabolic rate found so frequently in our patients is not concerned with 
thyroid function directly. If the data previously acquired in relation to blood 
cholesterol are correct, our findings are in accord with this hypothesis. Our blood 
cholesterol figures, so far, varj^ without any relation to the basal metabolic rate and 
are, for the most part, entirely within normal limits. 

We have thus brought to a head, in this year, our studies on these patients vnth 
low basal metabohsm; first, having established their frequency in psychiatric 
patients; second, having demonstrated their normal reaction to iodides, salicy- 
lates and added protein as far as their nitrogen metabolism was concerned; third, 
in demonstrating their normal reaction to other food stuffs as measured by the 
specific dynamic action they cause; and, fourth, in relation to their blood choles- 
terol. It seems, therefore, that we are amply justified in seeking elsewhere for 
the explanation of this phenomenon. As is well known, the introduction of a new 
method into clinical medicine causes intense enthusiasm and frequent application 
of it within the few years of its inception. Gradually the method sinks to its 
proper level as data are accumulated to show its limitations and usefulness. It is 
of considerable importance to point out that there is a distinct contribution of 
Psychiatry to Internal Medicine in the proof that a low basal metabolic rate may 
be due to many conditions other than hypothyroidism and that many of these 
conditions are, at the present time, obscure. It is important that we be not car- 
ried away with the endocrine possibility of this, and falsely assume that because 
the thyroid gland is responsible for 40 per cent of the fundamental rate of chemical 
change in the body that the other 60 per cent is likewise controlled by other glands 
It seems not at all unlikely that the explanation of the rate may be found in the 



22 P.D. 137 

central nerv^ous system itself, although much further work must be done in order 
to rule out other factors. 

The studies on the effect of iodides and salicylates on the nitrogen metabolism 
from the pharmacological point of view has been completed insofar as the facilities 
and type of patients in this hospital permit. These studies have been carried on 
over many years. It has been shown that iodides taken by mouth in small doses 
over a short period (3 days) cause an increase in the nitrogen excretion of the 
urine when the nitrogen intake is constant. The same has been shown to be true 
of salicylates, thus confirming older work. However, it has also been shown that 
the type of nitrogen excreted after the administration of these two drugs is differ- 
ent, that mobilized by idoides containing little or no sulphur, whereas in that 
mobilized by sahcylates the sulphur content runs parallel to the nitrogen content 
of the urine, both being increased. Similarly, in the case of iodides, it has been 
shown that the nitrogen excreted is accompanied by a greater increase in the 
phosphorus excretion than is the case with sahcylates. In the past year this ex- 
periment has been carried a step further to show that a continued administration 
of iodides in increasing doses, over a longer period (12 days) is accompanied by 
a continued disturbance in the nitrogen excretion. As a by-product of these 
studies, interesting relationships were established in accordance with the nature 
of the salts used in these experiments. This showed conclusively that in the case 
of both sahcylates and iodides, potassium salts delayed the excretion of nitrogen 
from the kidney, whereas the sodium and hthium either did not affect it or had 
the opposite effect. 

The plans for the coming year provide for a completion of the cholesterol and 
specific dynamic action studies, as well as an attack on certain other problems 
concerned with the metabolism in convulsive disorders. The work on iodides and 
salicylates is now being applied at the Peter Bent Brigham Hospital on pathological 
cases in an effort to throw more light on the nature of these phenomena. 

The routine work of the hospital has been done, as in the past, by four student 
internes. Comment on this system is superfluous beyond saying that it continues 
to work well. For a detailed consideration of its advantages and disadvantages, 
the reader is referred to pre^aous reports of this laboratorj^ 

The staff for the past year has been as follows: 

Chemists. — Mrs. Charles Kubik; Miss Nancy Underhill. 

Student Internes. — Frank Davenport, June, 1925, to June, 1928; George Raf- 
ferty, September, 1927; Horace Sweet, June, 1927; Louis Sweet, October, 1927; 
Anthony E. Peters, June, 1928. 

Publications for the past year have been as follows: 

"The Action of Salicylates on the Nitrogen Metabolism." Boston Medical and 
Surgical Journal, Vol. 197, No. 24, pp. 1121-1124, December 15, 1927. 

"Observ^ations on the Effect of Prolonged Administration of Iodides on the Nitro- 
gen Metabolism." Journal of Pharmacology and Experimental Therapeutics, 
Vol. XXXIII, No. 3, July, 1928. 

"The Effect of Salicylates on the Nitrogen Metabolism with Special Reference 
to the Effect of the Cation of the Salt." Journal of Pharmacology and Experi- 
mental Therapeutics, Vol. XXXII, No. 5, March, 1928. 

Respectfully submitted, 

G. PHILIP GRABFIELD, M.D., 
Chief of Bio-Chemical Laboratory. 

REPORT OF THE PSYCHOLOGICAL LABORATORY. 

To the Director of the Boston Psychopathic Hospital: 

The routine psychometric work has proceeded without special modification. 
An increasing amount of work is done with adults of superior psychometric rating, 
mainly with the Alpha test, as mentioned in the last report. The fundamental 
apparatus of psychometrics has undergone little change during the last five years, 
though distinct advances have been made along certain lines, notably for the pre- 
school period and in matters of vocational testing. 



P.D. 137 



23 



The laboratory cooperates in the material of "Psychological Abstracts," "The 
Psychological Index," and the "Child Development Abstracts." A number of 
reviews of psychological and medical books have been contributed to psychological 
journals through the writer, by members of the medical staff. As a member of 
the Division of Psychology and Anthropology of the National Research Council 
the writer participated in the Carlisle conference of experimental psychologists 
and has been occupied with various committee assignments growing out of this 
relationship. 

The calls made upon the laboratory ennce a growing concern for psychometrics 
in the community. A consideraV)le part of the writer's time has now to be spent 
in conferences with persons interested in careers in this field, or in various appli- 
cations of the techniques. Requests for such assistance, voluntary or compen- 
sated, are from time to time received from various institutions, and the laboratory's 
acquaintance with persons interested makes it commonly possible to meet these. 
The usual facilities in respect to training, etc., have been extended to other insti- 
tutions under the Department of Mental Diseases. 

Congestion of laboratory space makes it impossible to carry on work requiring 
elaborate equipment even conceding time and personnel from other interests. It 
has accordingly seemed unwise to make at present any special additions to the 
technical equipment of the laboratory. Improvements have been made in the 
furnishings, and the needs in this respect are fairly well met. 

Certain research projects have been carried on in cooperation with other insti- 
tutions. A series of scatter diagrams has been prepared illustrating various prop- 
erties and interrelations of important psychometric methods. These have been 
made in form for blue-printing to make them generally available. Further work 
on the more basic properties of psychometric methods is in progress with reference 
to problems of functional transfer, and the effect of practice on individual differ- 
ences. The indubitable fact of such transfer within limits, has led to study of the 
precise nature of these limits and the possibility of using certain psychometric 
methods reeducationally or even educationally. A case of memory defect of ob- 
scure origin is now being worked with intensively from this standpoint. The 
laboratory continues its close relationship with the Department of Human Engineer- 
ing of the General Electric Company and is at present cooperating with them on 
means to increase the reliability of certain vocational tests. 

From the standpoint of research by officers and students in the laboratory, Miss 
Z. A. Rosen has prepared a report on the interrelations of Stanford, Memory and 
Performance scales as used in the laboratory, w^orking largely under the super- 
vision of Miss Kendall. Miss Kendall also continued her work on the interrela- 
tions of the Stanford and Alpha scales. Mr. Brush completed two minor studies, 
one on substitute weights for the Standford-Binet weight test, another on time 
estimates during sleep. Miss Hatfield completed her doctoral dissertation re- 
ceiving the degree from Cornell. Mr. A. L. Miller cooperated in a further stand- 
ardization of the Kent-Rosanoff Association Test, and in a study of the short- 
answer method as applied to examinations in psychiatry. Mr. Brush, Miss Ken- 
dall and Mr. Young have also been specially interested in the non-reader problems 
that come to the laboratory's attention. 

In view of the long continued difficulties with regard to secretarial help, note is 
to be made of the very satisfactory situation now existing in this respect. 

As to changes in the staff, Mr. C. H. Johnson resigned as interne March 1, 192S, 
and is continuing in psychometric work at the Boston Y. M. C. A. Mr. R. A. 
Young came to the position vacated by Mr. Johnson. Miss Barbara Kendall re- 
signed June 9, 1928, to take up psychological work with the Children's Center at 
St. Louis. Dr. L. M. Hatfield resigned September 1, 192S, to teach in the Univer- 
sity of Illinois and Mr. Brush on the same date to teach in the University of Maine 
Dr. Hatfield was succeeded by Miss Wilda Rosebrook of the Michigan Home and 
Training School, Lapeer, Michigan; and Mr. R. A. Young who had been psycho- 
metrist since the resignation of Miss Kendall assumed the duties vacated by Mr. 
Brush. The former position was then taken over by Mrs. E. C. Whitman, previ- 
ously connected with this laboratory in various capacities. 



24 

Publications have been as follows: 



P.D. 137 



Wells, Dr. "Values in Social Psychology." From "The Unconscious: A Sym- 
posium." Alfred A. Knopf. 

Wells, Dr. A Review of E. Miller. "Types of Mind and Body." The Personnel 
Journal. 

Wells, Dr. "Psychogenic Factors in Emergentism and Allied Views." Journal 
of Philosophy. 

Wells, Dr. "The Psychometric Factor in Medical Problems." American Jour- 
nal of Psychiatry. 

Wells, Dr. Review of J. B. Watson's "The Psychological Care of Infant and 
Child." The Saturday Review of Books and Literature. 

Book reviews and abstracts communicated by members of the medical staff 
under 16 titles to American Journal of Psychology, Psychological Bulletin, The 
Nation's Health, Psychological Abstracts. Abstracts of Periodical Literature by 
members of the laboratory staff, 160 titles. Psychological Abstracts. 

F. L. WELLS, 
Chief of Psychological Laboratory. 

REPORT OF NEUROPATHOLOGICAL LABORATORY. 
To the Director of the Boston Psychopathic Hospital: 

The following is the report of the pathological work of the Hospital during the 
year ending November 30, 1928. 

The Pathologist to the Department of Mental Diseases has as usual been in 
charge of the laborator5^ In the absence of the writer for seven months in Europe, 
her predecessor Dr. Myrtelle M. Canavan ably managed the work. 

There were 63 deaths and of these 10 were autopsied at the hospital, 16 more 
passed into the hands of the Medical Examiner and post mortem examinations 
were made by him. This makes the total autopsy percentage 41.2. The number 
of Medical Examiner's cases is unusually large this year. The majority of these 
became medico-legal because of alcoholism. 

The Hospital has not manj^ autopsies, but the nature of the cases makes it ad- 
visable that the body organs and the central nervous system both be examined for 
microscopic changes. This, of course, necessitates a large amount of technical 
work and microscopic study, and warrants in my opinion a part-time Assistant 
Pathologist as was formerly customary in this hospital. It would be desirable 
to have someone in this position who has had some neuropathological training 
and requires, therefore, no supervision. 

The autopsies, though not numerous, could be looked after more satisfactorily 
if the post mortem time could be shortened. It is unfortunate that the average 
time elapsing before a case is autopsied in the Hospital is between 10 and 11 hours, 
whereas in one of the other state hospitals over 30 miles distant, the time is between 
9 and 10 hours. When one considers that it takes one and one-half to two hours 
from the Boston Psychopathic Hospital to this hospital by train and slightly less 
by automobile the difference seems notable. It is always desirable to have tissues 
as fresh as possible for microscopic examinations, but in order to make satisfactory 
preparations for the study of neuroglia it is even more necessary to have speci- 
mens fixed as soon after death as possible as the oligodendroglia, for example, 
undergoes post mortem changes very rapidly. 

Of the cases autopsied at the hospital four deaths were due to acute infections, 
two were due to brain tumor. One of these was of an unusual type — a carcinoma 
of the choroid plexus. One pecuHar type of constricting ulcer of the intestine, 
which was thought at autopsy to be tuberculous, was found on microscopic exami- 
nation to be an adenoma. One death was due to metastatic carcinoma. These 
cases make the percentage of deaths due to new growth unusually high this past 
year and the general pathology found was more interesting than that in the central 
nervous system with the exception of the two brain tumor cases. 

Three members of the Clinical Staff have expressed their wish to do some work 
in the Laboratory, but the number of clinical cases is such that time for laboratory 
work is hardly to be hoped for. 



P.D. 137 



25 



Paul E. Tivnan, the bacteriological interne, reports the following work done 
for the wards of the Hospital: — Blood cultures, 24; throat cultures, 12; spinal 
fluid cultures, 1 ; stool cultures, 2 ; miscellaneous, 8; smears, 7; widals, 6; sputum 
examinations, 1; dark field examinations, 1. 

MARJORIE FULSTOW, 
Acting Chief of Neuropathological Laboratory. 

REPORT OF THE DEPARTMENT OF THERAPEUTIC RESEARCH. 
To the Director of the Boston Psychopathic Hospital: 

During the year just past the treatment of cases of neurosyphlis has been con- 
tinued without any important change from that of the previous year ; that is, the 
chief reliance in the treatment of these cases has been placed on tiryparsamide and 
febrile methods. The use of tryparsamide in this clinic dates from June, 1923, 
and of malaria from February, 1924. Thus a period of five and four and one-half 
years respectively has transpired during which these methods have been used 
rather extensively. It is therefore possible to analyze the experience as to the 
effect of the type of treatment now being used. It may be stated rather emphati- 
cally that considerable improvement and apparent arrest of the paretic process 
occur. These methods are very superior to the previous treatments which were 
intensively and extensively used in this clinic during the preceding ten years. 
Further experience has corroborated the statement made in the Annual Report 
of the previous year that about one third of the cases treated made good and con- 
tinued improvements. While this is extremely encouraging it is by no means 
entirely satisfactory and one hopes for and tries to find methods that will give a 
still better percentage of good results. Without any major change in principle 
of treatment there is a probability that better results may be obtained by an im- 
provement in the technique or methods of procedure. Questions to be answered 
are whether larger doses of tryparsamide, two or more courses of fever, or a com- 
bination of fever and tr^^'parsamide will lead to greater success. These questions 
are being studied and experience in the next few years will answer them at least in 
part. 

During the last two years a considerable portion of the patients receiving febrile 
treatment have had air injected into the ventricles of the brain for the purpose of 
determining their size by X-ray studies, in an endeavor to learn if one can draw 
any prognostic conclusions therefrom. The study of the ventriculograms would 
seem to indicate the amount of brain atrophy that has occurred. A preliminary 
analysis shows that although there are marked differences in the sizes of the ven- 
tricles of different cases, and therefore, one concludes, a difference in the amount 
of atrophy that has occurred, yet it does not seem to follow that the best results 
are obtained in the cases with small ventricles nor that the poorest results are 
always obtained in the cases with large ventricles. This failure to find a definite 
correlation between size of ventricles and outcome of treatment is similar to the 
failure that is found in the use of other data in drawing prognostic conclusions. 
Thus the degree of apparent deterioration, the duration of the psychosis, the age 
of the patient, or the period of existence of syphilis are untrustworthy guides. It 
is further apparent that the size of the ventricles does not correlate with the dura- 
tion of the psychosis. Further study is needed however to draw precise conclusions 
and this study is being continued. 

In the previous report it was noted that psychometric examinations at various 
intervals are made on the patients who are undergoing treatment in order to have 
a measurement of results that is relatively free from the fault of the individual in- 
terpretation, or otherwise stated in order to remove the personal etiuation as far 
as is possible. A study of the data so far acquired shows that in many instances 
there is a very marked increase in the intelligence (juotient as obtained before 
and after treatment. This has a considerable bearing on the matter of so called 
dementia or deterioration in the organic psychoses, and will form a basis for a 
rather detailed study of the problem of dementia. It is interesting to note that 
the improvement in intelligence as indicated by psychometric examinations is not 
by any means an invariable indicator of an improved social adaptability. Thus 
we have patients who, despite a marked increa.se in the intelligence rating, have 
been unable to resume their places in the community and have needed continued 



26 P.D. 137 

hospitalization, whereas on the other hand patients who have shown no improve- 
ment, or indeed in some cases have shown an actual deterioration psychometrically 
measured, have been able to return to their homes and take up their former occu- 
pations and have become self-supporting. These data are being carefully com- 
piled and results will be published in the future. 

The work with febrile therapy has been subsidized in part by a grant of money 
from the Division of Mental Hygiene of the Massachusetts Department of Mental 
Diseases. Through the courtesy of Merck and Company we have continued to 
receive tryparsamide for use in our clinic free of all charge. The De Lamar Mo- 
bile Research Fund of the Harvard Medical School has granted us financial aid 
in a study of the salt and water metabolism in fevers. It has thus been possible 
to study the effect of malarial fever on the salt and water balance in our patients. 
This work has been largely directed by Dr. Frank Fremont-Smith of the Depart- 
ment of Neuropathology of the Harvard Medical School. Mrs. Emily Kubik has 
been employed to carry on the technical procedures of this work, which it is ex- 
pected will be completed about February 1, 1929. 

The routine work of examination and treatment has been continued without 
any material or outstanding changes during the year and the number of patients 
dealt with has been almost the same as that of the preceding year. There has 
been no change in the personnel during the current year. 

Publications from the Department. 

Solomon, H. C. ''What Causes Mental Diseases?" Hygeia, Juh^-August, 1928. 

Solomon, H. C, and Berk, Arthur. ''Prolonged Treatment in Neurosyphilis." 
American Journal of Syphilis, November, 1928. 

Lyday, June F., and Solomon, Maida H. "The Problem of the Supply of Psychia- 
tric Social Workers for State Hospitals." American Journal of Psychiatry, 
Vol. Vn, No. 4, January, 1928. 

Solomon, Maida H. "Social Work and Syphilis." The Commonhealth, Vol. 15, 
No. 3, July-August-September, 1928. 

H. C. SOLOMON, 

Chief of Therapeutic Research. 



STATISTICS OF SYPHILIS SERVICE. 
October, 1927 — September, 1928. 

New. Old. Total. 

House cases 188 15 203 

Number of persons who reported to Out-Patient 

Service (patients and relatives) . . . 154 173 327 

Visits made by 419 persons. 

Number of cases who reported for treatment (new and first time this 



year) 191 

Treatments given House and Out-Patients (new and relatives) : 

Arsphenamine . . 353 Neoarsphenamine . . 223 

Bismuth . .116 Sodoku .... 29 

Drainage .... 4 Sulpharsphenamine 1 

Intraspinous ... 2 Tabetic training ... 44 

Malaria .... 45 Tryparsamide . . 2,361 

Mercury . . . .165 Typhoid vaccine ... 49 
Ventriculographies . . 17 



Percentage of families followed who were examined . . . . 83 . 58 

Percentage of relatives followed who were examined . 63 . 49 

Percentage of families examined showing evidence of syphilis . . 11.11 

Percentage of relatives examined showing evidence of syphilis . . 9 . 73 



P.D. 137 27 

REPORT OF THE CHIEF EXECUTIVE OFFICER. 
To the Director of the Boston Psychopathic Hospital: 

The position of Chief Executive Officer has been filled by three different men 
during the year covered by this report. Dr. Clarence A. Bonner, now Superin- 
tendent at Danvers State Hospital, resigned December 26, 1927, and his successor, 
Dr. Roderick B. Dexter, now Superintendent at Foxborough State Hospital, re- 
signed October 29, 1928. To the wisdom and tireless efforts of these two is due 
the full credit for an executive organization that leaves little to be desired. 

In addition to the regular routine of executive work, much has been done by 
way of repairs and betterments during the past year. 

The grounds have been improved by the addition of several new posts and ex- 
tensive repairs to the iron fence at a cost of $1,315.65. Shrubbery has been thor- 
oughly pruned and is now much more attractive in appearance. 

The sum of $245.25 has been expended for general roofing repairs. 

The sum of $2,265 has been expended for the replacement of six iron risers by 
brass piping. It is hoped that in the near future all of the original cold water 
iron plumbing can be replaced with brass. The original plumbing had become so 
occluded with rust and debris that in many cases there was insufficient water 
pressure for the flushing of the toilets. 

The sum of $1,620 has been expended for inside painting. 

The sum of approximately $5,520 has been expended for the installation of new 
X-ray equipment that is about to be put into operation. 

A new Electrocall Paging Svstem has just been installed throughout the hospi- 
tal at a cost of $707.30. 

A radio set with loud speakers in all of the wards and in the Occupational Therapy 
Department is now in process of installation and should be in operation before 
Christmas. 

New ward equipment comprising adjustable beds, crib beds, bedside tables, 
screens, reclining chairs, and a wheel chair, at an approximate cost of $375 has 
just been purchased. 

New office equipment comprising three typewriter desks, four typewriters, two 
bookcases, forty transfer files, and one dictaphone machine, at an approximate 
cost of $685 has been purchased and is now in use. 

New laboratory equipment and clinical instruments have been purchased at an 
approximate expense of $585. 

The turnover in permanent personnel has been light and nearlj^ a full quota has 
been maintained during the year. 

The problem of feeding in a satisfactory manner, with a minimum of waste, is 
a vexatious one. There is often a variation of 10 per cent from day to day in the 
patient population, and of more importance perhaps is the marked daily variation 
in the food requirements for the wards depending upon the relative physical con- 
dition of the patients on any given day. Attempts under the present system of 
feeding to reduce the issue of food to a point where waste is reduced to a desired 
minimum, have invariably resulted in under nutrition of patients. It would seem 
advisable that careful study be given to the cafeteria system of feeding for both 
patients and employees as a means of greatly reducing waste and serving a greater 
variety of food in a more palatable form. 

The care of acutely disturbed patients is one of the most important problems 
of the hospital and continues to receive detailed study. 

Respectfully submitted, 

ARTHUR N. BALL, M.D. 

Chief Executive Officer. 

REPORT OF THE SOCIAL SERVICE DEPARTMENT. 
To the Director of the Boston Psychopathic Hospital: 

I hereby present the report for the Social Service Department for the year, 
December 1, 1927, to November 30, 1928. 

Three members of the staff have resigned during the year, two because of ill 
health: namely. Miss Suzie L. Lyons, who had boon in oliargo of the dopartmont 
for over seven years, and Miss Carolyn E. Rising, who had been manager of the 



28 P.D. 137 

Out-Patient Department for over two years. Miss Florence Gilpin, an assistant 
in social work, found it necessary to leave so that she could be with relatives in 
another citj'. 

Miss Villa T. West, a graduate of the Simmons School of Social Work, is the 
Out-Patient manager. 

Miss Ethel Goodwin, graduate of Brown University and formerly an assistant 
in social work at Taunton State Hospital, has taken Miss Gilpin's place, while 
Miss Ethel Gleason, a graduate of the Summer Institute held by the Simmons 
College School of Social Work, occupies a vacancy which had been existent for 
many months. 

Despite the many changes in staff the work of the department has proceeded 
along the lines laid down by the previous staff. Cases are referred for the same 
reasons as before, for example, a detailed investigation is desired in the case of 
patients who have been sent in by the courts for a report on their mental state, or 
in other cases because there is no informant to come to the hospital, or because 
there is a discrepancy in the information obtained from the patient and relatives. 
As a majority of the cases referred are in the hospital for only a ten-day period, 
investigations have to be carried on very rapidly. Instead of waiting for the ward 
physicians to refer the court cases, social service now reviews the daily admissions, 
selects these cases and begins work at once. Frequently cases are sent on to other 
State hospitals before the investigation is completed and it is necessary for the 
Social Service Department in the State hospital to go on gathering history. Every 
effort is being made by this department to send on whatever material it has which 
will be of value to the other departments. 

Several meetings have been held with community social service organizations 
regarding matters of interrelationship. Policies have been worked out which 
should result in a higher degree of efficiency in the handling of the cases. 

Because of the addition to the staff of several special students and volunteer 
workers it has been possible to release one of the regular staff workers for the annual 
school survey. This is always an interesting project as many social service prob- 
lems are uncovered which throw light on the reason why the child is not progressing 
in school. In the case of non-readers especially has the social worker been of value 
in explaining to the parents that the child has a special disability instead of a 
general defect. 

The department has contributed to studies being made regarding the person- 
ality make-up of schizophreijic cases by obtaining detailed histories from infor- 
mants unable to come to the hospital. 

Contributions have again been received from the Junior Red Cross, the Junior 
League and The South Friendly Society of the First Unitarian Church, and other 
interested individuals. 

Respectfully submitted, 

ESTHER C. COOK, 
Head Social Worker. 

SOCIAL SERVICE STAFF. 
Suzie L. Lyons, head social worker, February 15, 1921. Resigned, June 16, 1928. 
Carolyn E. Rising, assistant in social service, December 21, 1925. Resigned, 
June 30, 1928. 

Florence Gilpin, assistant in social service, July 15, 1926. Resigned, June 2, 1928. 
Dorothy L. Whittaker, syphilis follow-up worker, September 26, 1927. 
Ethel L. Gleason, assistant social worker, June 11, 1928. 
Villa T. West, assistant social worker, June 11, 1928. 

Esther C. Cook, assistant social worker, April 16, 1928. Resigned, June 30, 1928. 
Esther C. Cook, head social worker, July 1, 1928. 



P.D. 137 



29 



SOCIAL SERVICE STATISTICS. 



October 1, 1927, to September 30, 1928. 

1. New C3iSes . . -1-47 

Adult (Male, 133; Female, 103) 236 

Minor (Male, 139; Female, 72) 211 

Over one third of these were court cases. 

2. Sources of New Cases: 

(No case is considered unless referred by staff physician.) 

House (16% of House admissions) ...... 293 

Out-Patient (14% of Out-Patient admissions) .... 152 

Jail Cases (cases examined at Jail, not committed to Hospital) 13 

3. Purpose for which New Cases are Considered: 

Medical-Social and Environmental Investigations .... 434 
Special investigation (Jail cases) ....... 13 

4. Nature of Social Service Rendered in New Cases: 

Treatment (case work, history taking, aid of family, rehabilitation 

and adjustment of patient to community life) .... 294 

Supervision (follow-up of patients in community) .... 73 

Special investigation ......... 44 

Slight service .......... 12 

5. Visits 5,028 

To patients and relatives in Hospital (all house cases are visited 
on ward before and during investigation) .... 1,933 

To patients or in the interest of patients in community (courts, 
employers, hospitals, teachers, etc.) ..... 3,095 

6. Closed Cases (Social problems involved in closed cases) : 

Personal ........... 436 

Family 228 

Community .......... 199 

7. Housing Conditions (every possible effort is made to bring back to 

physician accurate picture of setting from which patient is com- 
mitted) : 

Good Ill 

Fair 154 

Bad 106 

Not visited 57 

8. Technical Work (including Syphilis Service) : 

Telephone (necessary because insufficient time to make personal 

visits) 5,608 

(In, 2,044; Out, 3,564.) 

Letters 2,617 

9. Expense $417.86 

Outstanding Social Problems. 



Mental disorder, 175 

Mental defect, 55 

Syphilis, 18 

Alcoholism, 49 

Lying, 40 

Stealing, 25 

Poor environment, 93 

Sex dehnquency, 51 

Poor heredity, 54 

Temper tantrums, 27 

Physical disorder, 12 

Marital maladjustment, 19 

School maladjustment, 54 

Nervous and delicate mother, 5 

Divorce, 3 

Death of mother, 5 

Remarriage of father, 1 



Remarriage of mother, 1 

Industrial maladjustment, 41 

Lack of social contacts and recreational 

program, 123 
Auto-erotism, 8 
Lack of sex education, 5 
Court record, 13 
Indecent exposure, 5 
Breaking of probation, 4 
Seclusiveness, 26 
Unintelligent mother, 2 
Atypical personality, 8 
Non-support of family, 1 
Abusive lui.^band, 2 
Chorea, 2 
Speech defect, 5 
Meagre education, 11 



30 

No trade, 7 

Unfortunate love affair, 2 
Financial difficulties, 30 
Anti-social habits, 22 
Vacillating interests, 8 
Conduct disorder, 31 
Alcoholic parents, 6 
Lack of early training, 14 
Maladjustment in home, 81 
Fugues, 7 

Low-grade parents, 2 

Friendlessness, 2 

Unemployment, 13 

Loneliness, 5 

Bad companions, 30 

Irritability, 17 

Physical illness, 6 

I^egal difficulties, 37 

Indecent assault, 2 

Stubborn child, 3 

Idle and disorderly conduct, 5 

Sex perversion, 4 

Illegitimate pregnancy, 3 

Cruelty of parents, 5 



P.D. 137 



Anti-social habits, 9 
Drug addiction, 5 
Truancy, 12 
Prostitution, 11 
Promiscuity, 5 
Neurotic child, 18 
ImmoraUty, 4 
Neglect of children, 4 
Sensitiveness, 7 
Unstable personality, 8 
Forced marriage, 2 
Epilepsy, 3 
Forgery, 2 
Jealousy, 7 
Gambling, 1 
Marital difficulties, 12 
Dependency, 4 
Voluntary unemployment, 6 
Separation from children, 4 
Over-indulgent parents, 9 
Poor home hygiene, 17 
Illiteracy, 5 
Delinquency, 10 

White mother and colored father, 1 



Adjustments. 



Hospital care, 197 

Institutional care, 36 

Financial help, 45 

Legal assistance, 44 

Improved home hygiene, 114 

Cooperation of other agencies, 57 

Home adjustment, 124 

Reeducation of parents, 91 

Industrial adjustment, 53 

Recreational program, 120 

Cooperation of priests an^ clergymen, 22 

Supervision in the community, 21 

Return to court, 46 

Removed to another community, 3 

Discharged to private physician, 4 



School adjustment, 68 
Industrial adjustment, 25 
Physical treatment, 7 
Cooperation of family, 66 
Cooperation of friends, 46 
Special training, 32 
Foster home, 6 
Employment, 11 
Vocational training, 1 
Psychotherapy, 2 
Sent to camp, 8 
Special training, 32 
Foster home, 6 
Employment, 11 
Vocational training, 1 



REPORT OF THE PRINCIPAL OF THE SCHOOL OF NURSING. 
To the Director of the Boston Psychopathic Hospital: 

I herewith present the annual report of the Nursing Department for the year 
ending November 30, 1928. 

On Nursing Service: Principal of the School of Nursing, 1; assistant principal, 
1; nurse instructor (full time), 1; female supervisor (night), 1; male supervisor 
(day), 1; assistant supervisors, 2; head nurse, operating room, 1; head nurses, 
wards, 7; assistant head nurses, 2; student nurses, 12; female attendants, 8; 
male attendants, 14. 

Head Nurses resigned: Miss Mary Dardis, Mrs. Caroline Cooper, and Miss 
Evelyn Wright. 

Head Nurses appointed: Miss Olia Butler; Miss Caroline Slade, a graduate of 
the Waltham Hospital, and Miss Margaret Davis, a graduate of the Cambridge 
Hospital. Both these nurses have taken the affiliated course here. 

During the year 45 affiliated students completed the course. 

Special Nursing: Number of special nurses, 26. Total number of weeks in 
wards, 48. 

In May of this year the Waltham Hospital withdrew affiliation because of the 
shortage of nurses in their own hospital. 



P.D. 137 31 

The Beth Israel Hospital sent two extra nurses for affiliation during the summer 
and was glad of the opportunity, as the demand for this course by the students 
exceeded the number we were able to accommodate. 

November first we started an affiliated course in psychiatric nursing with the 
New England Deaconess Hospital. This hospital has agreed to send us two 
student nurses every three months. 

Three more accredited general hospitals have expressed the desire to send their 
student nurses here for an affiliated course, but we are unable to consider it, be- 
cause of the lack of accommodation. This seems to be the only drawback in in- 
creasing affiliation, as we need more nurses. The advantage of having piipil 
nurses from general hospitals in a psychopathic hospital has been demonstrated 
on the wards by the way the student nurses have adapted themselves to the work 
and by their tact and judgment manifested in handhng difficult cases, as well as 
the care given the physically ill patients, which number far exceeded those of 
previous years, especially in the female receiving ward. 

In closing I wish to express my appreciation to all for their cooperation and 
support during the year. 

Respectfully submitted, 

MARY FITZGERALD, 

Principal of the School of Nursing. 

REPORT OF THE OCCUPATIONAL THERAPY DEPARTMENT. 
To the Director of the Boston Psychopathic Hospital: 

The work of the occupational therapy department has been carried on without 
any outstanding changes. At present we receive into the occupational center all 
patients who are well enough to leave their wards. By making use of the porches 
and sun parlor we are sometimes able to care for a type of patient who is not yet 
ready to concentrate upon work, but who, nevertheless, may profit greatly from 
the stimulus furnished by coming from the ward into the department. 

The work for the women patients seems to be on a satisfactory basis. On the 
whole they are very appreciative of the privileges of the department and we feel 
that they receive much profit from a therapeutic standpoint as well as pleasure. 
The work with the men is more difficult to adjust satisfactorily. This is partly 
because, on the whole, they seem to be more transient in their stay, and also be- 
cause of certain apparently unavoidable distracting interests. However, in many 
cases the work is greatly needed and good results are secured. We do feel that 
we have not been able to arrange a proper schedule for the children who are from 
time to time received into the hospital. These children are so varied in their 
needs that with our limited facilities it has been almost impossible to arrange an 
adequate program for them. For many of them it would be helpful if some sort 
of regular academic instruction could be provided, but their condition and length 
of stay are so uncertain that anything of the sort would be difficult to arrange. 
However, the number of children admitted is not large enough to render the situ- 
ation acute at present. 

An estimate of the articles produced in the department has been recently made 
and the value set at $686.80. We try constantly to keep in touch with the needs 
of the wards and to do the best we can to meet the demand for curtains, rugs, 
table covers, cushions, and various other furnishings. From the point of view of 
the occupational therapist the principal value in this production is tlie great variety 
of kinds of work which can be provided for the patients. It is not possible or de- 
sirable to run a department of this type on a basis of standardized production; 
the work must be planned so that it will be flexible, and as far as possible, provide 
occupation for many types. We have to provide for the dull and deteriorated, 
the patient with poor eyesight or poor motor control, the excited patient, the 
irritable and obstinate, the depressed, and the retarded cases who l)l()ck at the 
slightest necessity for decision. All these must l)e considered as well as the pa- 
tient who works practically normally, and sometimes those witli superior ability. 
Furthermore, a patient must feel that the tiling he is doing has value of some sort. 
Even a deteriorated patient is often c^uick to resent it if he feels that the thing he 
is doing is provided merely to keep him busy and has no further significance. 



32 P.D. 137 

The worker has the double task of keeping first in her own mind the value which 
she hopes the patient will receive and at the same time of planning work which 
shall be intrinsically of sufficient value to command the cooperation of the worker. 
There is a certain respect for human labor which an occupational therapist comes 
to feel. In a situation of this sort the work of furnishing the wards seems in many 
ways the best solution of the problem which can be found. When the patients 
ask, as they frequently do, what becomes of the things made in the department, 
it is always a satisfactory answer to call their attention to the furnishings in use 
about the hospital which were made in the department. 

When a department is run on this basis there is one thing which must be taken 
into consideration. The department is not able to finance itself directly or to 
have a cash income as is the case with departments which are run on sales. Its 
expense must largely be a part of the general budget of the hospital. However, 
when the value of the goods produced is credited to it, the department will turn 
back to the hospital considerably more than the value of the materials used. 
When running on this basis it is usually necessary to be satisfied with simpler and 
less expensive materials, but it is not difficult to make the adjustments necessary 
to meet this requirement. 

Besides the patients who can be interested in the general work of the depart- 
ment there is another type of patient to whom an appeal can be made only on 
personal grounds. Such a patient can often be stimulated to interest by arousing 
a desire to make gifts for a relative at home. Sometimes activity can best be 
aroused by this desire for contact with friends. To meet this need it is almost 
essential that the operation of the department should be flexible enough to permit 
of the purchase by the patient of the article he has made at approximately the cost 
of the material. With this outlet added to the regular work of the department 
the questions of the types of work to be done and the disposal of products are very 
largely solved. 

During this year we have tried to give more attention to the needs of the affiliated 
student nurses. 

A lecture has been given to each group explaining something of the theory of 
occupational therapy and showing the way in which occupational therapy can be 
of use to the nurse. Each student is also received into the department for two 
weeks' training in order to give her the opportunity of participating in the occu- 
pational activities of the hospital. The time is very short, but we hope to accom- 
plish several things even with this limitation. 

1. We try to have the nurse get a general understanding of what occupational 
therapy means and of what the worker is trying to accomplish. In order to have 
effective cooperation between the nursing staff and the occupational therapy 
worker it is necessary that each should understand something of the ideals, also 
of the difficulties of the other. 

2. We hope to emphasize the responsibility of the nurse for the morale of the 
patient. In the Occupational Therapy Department the nurse cannot help realiz- 
ing that she must deal not simply with the bodily needs of the patient but with 
the patient as a personality. 

3. We try as far as possible to give a little experience in actual crafts which may 
be of use in the occupation of the convalescent. The nurse may well find herself 
in a situation where even the slight knowledge of basketry and weaving which we 
are able to give, will be of considerable value, and of still more value will it be if 
she has an idea of the way in which it is possible to adapt any occupation which 
may be at hand to the patient's advantage. 

We have continued our supervision of recreation for the patients. It has been 
felt that the small informal evening parties which have been held in the sun-parlor 
of the department have proved to be very successful from the standpoint of the 
patient. We make games of various sorts a feature of these parties so as to arouse 
a group interest and in order to furnish a stimulus for those who do not join in 
other activities. These parties have been kept very simple involving little work 
and slight expense and yet they furnish a considerable social outlet for the patients. 
Besides these small parties we have occasional dances in the assembly hall for 
which we make more preparation and which are participated in quite generally 
by both patients and employees. 



P.D. 137 33 
During the year we have had a fair allowance of supplies and at the end of 

the year we were glad to receive as equipment an additional work bench for wood 

work and also a small jig saw. 
The department owes much to the loyal and efficient work of Miss Dorothy 

Hayden, assistant therapist. Much of the stability of the department is due to 

her continued service. 
The statistics of the department are as follows: 
Total number of articles produced, 34,670. 
Forms printed, 22,300. 

Average daily attendance, 40. Women, 21 ; Men, 19. 
Enrolment for year, Women, 503; Men, 621. 

Respectfully submitted, 

ETHELWYN F. HUMPHREY, 

Head Occupational Therapist. 

PUBLICATIONS FROM THE CLINICAL SERVICE AND LABORATORIES. 
Bowman, K. M. "The Mental Hygiene of Adolescence." The Jewish Advocate, 
February 9, 1928. 

Bowman, K. M. "Schizophrenia." Volume 5 of the Association for Research in 
Nervous and Mental Disease, Chapter XVI — "Endocrine and Biochemical 
Studies in Schizophrenia." 

Bowman, K. M. "Medical and Social Study of One Hundred Cases Referred by 
the Courts to the Boston Psychopathic Hospital." Mental Hygiene. 

Bowman, K. M. "Factors Determining the Development of Natural and Un- 
natural Habit Movements. Dental Cosmos, January, 1928. 

Campbell, C. M. "The Prevention of Mental and Nervous Disorders." The 
Canada Lancet and Practitioner, Toronto, February, 1928. 

Campbell, C. M. "Some Problems of the Functional Psychoses." American 
Journal of Psychiatry, Vol. VII, No. 6, May, 1928. 

Campbell, C. M. "Crime and Punishment, from the Point of View of the Psy- 
chopathologist." Journal of the American Institute of Criminal Law and Crimi- 
nology, Vol. XIX, No. 2, Part 1, p. 245. 

Grabfield, G. P. "The Action of Salicylates on the Nitrogen Metabolism." Bos- 
ton Medical and Surgical Journal, Vol. 197, No. 24, pp. 1121-1124, December 
15, 1927. 

Grabfield, G. P. "Observations on the Effect of Prolonged Administration of 
Iodides on the Nitrogen Metabolism." Journal of Pharmacology and Experi- 
mental Therapeutics, Vol. XXXIII, No. 3, July, 1928. 

Grabfield, G. P. "The Effect of Salicylates on the Nitrogen Metabolism with 
Special Reference to the Effect of the Cation of the Salt." Journal of Pharma- 
cology and Experimental Therapeutics, Vol. XXXII, No. 5, March, 1928. 

Solomon, H. C. "What Causes Mental Diseases?" Hygeia, July-August, 192S. 

Solomon, H. C, and Berk, A. "Prolonged Treatment in Neurosyphilis." Ameri- 
can Journal of Syphilis, November, 1928. 

Solomon, M. H., and Lyday, J. F. "The Problem of the Supply of Psychiatric 
Social Workers for State Hospitals." American Journal of Psychiatry, Vol. 
VII, No. 4, January, 1928. 

Solomon, M. H. "Social Work and Syphilis." The Commonwealth, Vol. 15, No. 
3, July- August-September, 1928. 

Wells, F. L. "Values in Social Psychology." From "The Unconscious: A Sym- 
posium." Alfred A. Knopf. 

Wells, F. L. A Review of E. Miller. "Types of Mind and Body." The Per- 
sonnel Journal. 

Wells, F. L. "Psychogenic Factors in Emergentism and Allied Views." Journal 
of Philosophy. 

Wells, F. L. "The Psychometric Factor in Medical Problems." American Jour- 
nal of Psychiatry. 

Wells, F. L. Review of J. B. Watson's "The Psychological Care of Infant and 
Child." The Saturday Review of Books and Literature. 



34 



P.D. 137 



VALUATION. 

November 30, 1928. 
Real Estate. 



Land, 2 acres 
Buildings 



Travel, transportation and oflBce expenses 

Food 

Clothing and materials 
Furnishings and household supplies 
Medical and general care . 
Heat, light and power 
Farm ..... 
Garage, stables and grounds 



Personal Property. 



$45,060.00 
583,028.07 

$628,088.07 

$3,804.10 
3,557.10 
1,263.48 
20,764.44 
18,506.75 
1,366.43 

. 141.65 

Repairs 1,396.92 

$50,800.87 

Summary. 

Real estate $628,088.07 

Personal property 50,800.87 

$678,888.94 

FINANCIAL REPORT. 

To the Department of Mental Diseases: 

I respectfully submit the following report of the finances of this institution for 
the fiscal year ending November 30, 1928. 



Income 
Board of Patients 
Reimbursements 



Cash Account. 
Receipts. 



$9,520.50 
4,267.16 



Personal Services: 

Reimbursement from Board of Retirement 
Sales: 

Food 

Repairs, Ordinary .... 
Arts and Crafts Sales .... 



$85.70 
67.45 
80.85 



Total sales 
Miscellaneous : 

Interest on bank balances 

Rent 

Sundries 



$211.72 
1,800.00 
148.00 



Total income ....... 

Maintenance. 

Balance from previous year, brought forward 
Appropriations, current year: 

Original appropriation ...... 

Additional appropriation, August 31, 1928 

Total 

Expenses (as analyzed below) ...... 

Balance reverting to Treasury of Commonwealth . 

Analysis of Expenses. 



Personal services .... 
Religious instruction .... 
Travel, transportation and office expenses 

Food 

Clothing and materials 

Furnishings and household supplies 

Medical and general care . 

Heat, light and power 

Garage, stable and grounds 

Repairs, ordinary .... 

Repairs and renewals 

Total expenses for Maintenance 



Speclal Appbopriations. 



Balance December 1, 1927 . 
Appropriations for current year 



Total 

Expended during the year (see statement below) 
Reverting to Treasury of Commonwealth 



Balance November 30, 1928, carried to next year 



$13,787.66 
91.44 



234.00 



2,159.72 
$16,272.82 



$3,489 . 60 

237,900.00 
7,190.00 

$248,579.60 
239,299.09 

$9,280.51 



$154,305.05 
1,040.00 
5,736.82 
34,675.93 
1,182.57 
4,671.88 
17,399.44 
11,989.21 
128.02 
3,209.52 
4,960.65 

$239,299.09 



$5,800.00 



$5,800.00 
198.21 



$5,601.79 



P.D. 137 



35 



Object. 


Act or 
Resolve. 


Whole 
Amount. 


Expended 
during 
Fiscal Year. 


Total 
Expended 
to Date. 


Balance 
at End of 
Year. 


X-ray equipment 


Acts of 1928, 
Chap. 127, 
Sec. 5 


$5,800.00 


$198.21 


$198.21 


$5,601.79 



Per Capita. 

During the year the average number of inmates has been 87.93. 
Total cost for maintenance, $239,299.09. 

Equal to a weekly per capita cost of $52.05 (52 weeks to year). 

Receipt from sales, $234.00. 

Equal to a weekly ijer capita of $0.0508. 

All other institution receipts, $16,038.82. 

Equal to a weekly per capita of $3.4884. 

Net weekly per capita $48.52. 

Respectfully submitted 

ELIZABETH LIBBER, Treasurer. 

STATISTICAL TABLES. 

As Adopted by the American Psychiatric Association 
Prescribed by the Massachusetts Department of Mental Diseases. 

Table 1. General Information. 

Data correct at end of hospital year, November 30, 

1. Date of opening as a hospital for mental diseases, June 24, 1912. 

2. Type of hospital: State. 

3. Hospital plant: 

Value of hospital property : 

Real estate, including buildings ....... 

Personal property .......... 



1928. 



$628,088.07 
50,800.87 



Total 



$678,888.94 



Total acreage of hospital property owned: 2.04 acres. 
4. OflBcers and Employees: 



Actually in Service at 
End of Year. 



Vacancies at End 
of Year. 



Superintendents 
Assistant physicians 
Medical internes . 

Total physicians . 

Resident dentists . 
Graduate nurses . 
Other nurses and attendants . 
Occupational therapists 
Social workers 

All other oflScers and employees 
Total oflBcers and employees 
Note: The following items, 5-10 



M. 


F. 


T. 


M. 


F. 


T. 


2 




2 








10 


3 


13 


1 


1 


2 


3 




3 








15 


3 


18 


1 


1 


2 


1 




1 








2 


12 


14 




2 


2 


17 


16 


33 










2 


2 










5 


5 




1 


1 


21 


46 


67 


1 


1 


2 


56 


84 


140 


2 


o 


7 



inc., are for the year ended September 30, 1928. 



5. Census of Patient Population at end of year: 

Actually in Hospital. 



Absent from Hospital 
but Still on Books. 





M. 


F. 


T. 


M. 


F. 


T. 


White: 














Insane 


40 


34 


74 


24 


23 


47 


Mental defectives . 


1 

3 


1 


1 
4 








All other cases 


3 


3 


6 


1 




1 


Total 


47 


38 


85 


25 


23 


48 


Other Races: 














Insane 


1 




1 


1 




1 


Total 


1 




1 


1 




1 


Grand total 


48 


38 


86 


26 


23 


49 



36 • P.D. 137 

Males. Females. Total. 

6. Patients under treatment in occupational-therapy classes, including 

physical training, on date of report ...... 20 24 44 

7. Other patients employed in general work of hospital on date of report 3-3 

8. Average daily number of all patients actually in hospital during year . 49.90 38.61 88.51 

9. Voluntary patients admitted during year ..... 2 5 7 
10. Persons given advice or treatment in out-patient clinics during year . 523 563 1,086 

Note: The following tables, 3-18, inclusive, are for the statistical year ended September 30, 1928. 

Table 2. Financial Statement. 
See treasurer's report for data requested under this table. 



P.D. 137 



37 







CO 
CO 


1,565 
340 


1 

1,906 

9 fiAO 


Total. 






lO CO 
00 CO 

CO r-i 


1 00 (M 
^ O 
00 05 



Q 

w 
O 

P3 

go 



o 

-♦o 



o 

> 



00 00 

00 t-H 



^ 00 o 
o ^ 



O —1 lO Tt< 
CO ^ O "H 

CO 



t>- <M CO CO 

00 

»-H r-1 



CO 05 05 00 
(M (N lO CO 
lO (M ^ 



^ CO 1^ 



CO r-H 

CO (M ^ 



00 C5 CO 
lO (M CO 

o 



r\ ^ CO '-^ 

H CO i-H 

CO CO 



r • CO ^ 

ptH T-H as Tt< 



05 05 O 



I o ^ 

CD Oi 
CO CO 



05 00 
^ CO 
05 C5 



00 ^ 
CO 00 cs 

CO CO (M 



CO C5 O C5 
»0 -rt^ CO 

T-H Ttt T-( 



^ 05 IXM 

(M l:^ lO 
"^ti <M 1-1 



-H (M 

(M CO 



1-H lO 

1— H 1— t 

o 



C-l 1-1 



00 C5 
UO CO 



o CO CO 

1-t (M 



CO 



CO ^ CO I l> CO (M lO I> I I 00 

,-1 T-H (M 1-H 



»C OtH |i-icO (MCOQOCO |(N 



r] O 00 05 

H Oi CO T-H 



r • (M CO 
HH CO l> ^ 



00 00 (M CO ^ I 
00 ^ 
1-1 <M 



o CO CO 

05 CO 00 



O <M (M O 1-H I CO 1-H CO 
05 (M 1-H CO 



CO 05 

00 



00 CO 
CO (N 



00 CO 



CO I 
CO 



CO I 



CO o 



CO CO 



H 00 1-HCO 1-HOOCO l'*'<:tH| t^<N 5;- coco 
5 lO Oi 05 UO CO kO 1-H O 



a 
o 



o >> 
d 



03 

. . bC 



e « 'I' 

C3 

PL, -tt 



o <u 

c3 ^ 



CJ 



Kl > 

c: bc g 

o b o 

o o • — ^ 



'a 

O 

c^ O . 

p c-r ^ J: 

CO Cfi CC »-i 



03 



.5 o 

1° 



tx"* 



XJ ^- V- c S 



38 P.D. 137 

Table 4. Nativity of First Admissions and of Parents of First Admissions. 



Nativity. 


Patients. 


Parents of Male 
Patients. 


Parents of Female 
Patients. 


INI. 


F. 


T. 


Fathers. Mothers. 


Both 
Parents. 


Fathers. Mothers. 


Both 
Parents. 


United States . 


54 


48 


102 


27 


30 


26 


27 


28 


24 


Austria .... 




2 


2 








2 


2 


2 


Belgium .... 


1 


_ 


1 






1 






_ 


Canada i . . . 


6 


8 


14 


13 


13 


11 


15 


14 


12 


England .... 






1 


1 






5 


5 


4 


Germany 


1 


1 


2 


2 


2 


2 


3 


3 


3 


Greece .... 


3 


_ 


3 


3 


3 


3 






— 


Holland .... 


1 




1 


1 


1 


1 








Ireland .... 




O 


1 R 
ID 


21 


19 


1 c 


11 


11 


1 1 
1 1 


Italy .... 


6 


1 


7 


7 


7 


7 


3 


3 


3 


Norway .... 
iroiana .... 


1 




1 


1 


1 


1 


1 




1 




1 


1 


2 


2 


2 


1 


1 


1 


Russia .... 




6 


6 


3 


3 


3 


6 


6 


6 


Scotland 


3 


1 


4 


3 


4 


3 


1 


1 


1 


Spain .... 




1 


1 








1 


1 


1 


Sweden . . 


2 


1 


3 


2 


2 


2 


1 


1 


1 


Other countries 


3 




3 


3 


3 


3 








Unascertained 








1 












Total .... 


91 


77 


168 


91 


91 


83 


77 


77 


70 



1 Includes Newfoundland. 



137 



•i 

eo 

►3 



"I 

eo 

J 
o 

eo 

•2 

eo 



Nativity 
unascer- 
tained. 


M. F. T. 




1 FoRBiGN Born. | 


TiMK IN United States before Admission. 


Unascer- 
tained. 


M. F. T. 




15 years 
and over. 


1 es 1 -»> «o 2 00 eo I 

^ 1 1 1 1 00 «0 CO CO CO 1 1 


28 21 49 


10-14 
years. 


M. F. T. 

I - 1 

1 - 1 


(M 
1 

C» 


5-9 
years. 


H ' ' ' ' 

fa 1 1 1 - 1 1 . 1 1 • 1 ■ 
«g 1 1 1 1 1 1 


■>«• 
CO 


Under 
5 years. 


fa - 1 < 1 1 - ' ' • ' ' 

s 


IT 9 9 


Total. 


^ •-iC4«DC4t«<or«C4aaco'<*<>oc4 1 


S 


^ — 1 —1 »o c>» c» eo «o eo i ^ -h »^ i 




^ l-^-H|U5C0CS00«COCO'V^I 


CO 


Nativb Born. | 


Parentage. 


Unascer- 
tained. 


M. F. T. 


1 


Mixed. 


^ «eQcoeoe>»«^ 1 1 -i 1 1 1 1 
fa- ' 1 - 1 . 1 . 1 I 1 1 

s "^^^ 


8 6 14 


Foreign. 


^ e<» CO t<- «o « o -H e>» ^ CO 1 i 1 
1 ^e^io^io 1 r — e^-H i i i 
^ c4oiiQ^iOM«e^ 1 -H 1 1 1 1 


00 

eo, 

00 


Native. 


o 00 eo CO •* CO ^ 1 1 
jj^- ieoc»eo'»«co«-"C«co»^ — —I i 

^ CO MS CO e>» C* 1 1 1 1 


26 24 50 


Total. 




2 


^ 1 <0 <0 03 >0 0> C4 CO C4 M 1 1 


00 


^ <«• «o ^ eo ^4 ^ 1 r 1 1 














^ «o e;* « w 00 « tN. eo l | gj 


1 

S 
< 






llllllllllllll 


Tot*] 



40 P.D. 137 

Table 5. Citizenship of First Admissions. 



Males. Females Total. 







54 




48 




102 


Citizens by naturalization ....... 




30 




17 




47 






7 




12 




19 


Total 




91 




77 




168 , 

1 


Table 6. Psychoses of First Admissions. 










Psychoses. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic psychoses 








2 


_ 


2 


2. Senile psychoses 








_ 


1 


1 


3. Psychoses with cerebral arteriosclerosis 








7 


2 


9 


4. General paralysis 








24 


4 


28 


5. Psychoses with cerebral syphilis ..... 








2 


1 


3 


6. Psychoses with Huntington's chorea .... 








— 


— 


— 


7. Psychoses with brain tumor ..... 








1 


2 


3 


8. Psychoses with other brain or nervous diseases, total 








7 


5 


12 


Other diseases ........ 


7 


5 


12 








9. Alcoholic psychoses, total ...... 








4 


1 


5 


Delirium tremens . . . . . 


1 




1 








Korsakow's psychosis ...... 


1 


1 


2 








Other types, acute or chronic 


2 




2 








10. Psychoses due to drugs and other exogenous toxins, total 














11. Psychoses with pellagra ...... 














12. Psychoses with other somatic diseases, total . 








1 


16 


17 


Delirium with infectious diseases .... 


_ 


1 


1 








Delirium of vmknown origin ..... 


1 


2 


3 








Cardio-renal diseases ....... 




3 


3 








Other diseases or conditions ..... 




10 


10 








13. Manic-depressive psychoses, total .... 








5 


15 


20 


Manic type ........ 


1 


4 


5 








Depressive type ....... 


3 


10 


13 








Other types ........ 


1 


1 


2 








14. Involution melancholia ...... 








1 


- 


1 


15. Dementia praecox (schizophrenia) .... 








19 


13 


32 


16. Paranoia and paranoid conditions .... 








2 


1 


3 


17. Epileptic psychoses ....... 








1 






18. Psychoneuroses and neuroses, total .... 








t 

X 


9 




Hysterical type ....... 




2 


2 








Other types ........ 


1 




1 








19. Psychoses with psychopathic personality 










1 


1 


20. Psychoses with mental deficiency ..... 








1 




1 


21. Undiagnosed psychoses ...... 








13 


13 


26 


22. Without psychosis, total ...... 














Total 




91 


77 


168 



P.D. 137 41 

Table 7. Race of First Admissions Classified with Reference to Principal 

Psychoses. 



Rack. 


Total. 


Traumatic. 


Senile. 


With 
cerebral 
arterio- 
sclerosis. 


General 
paralysis. 


With cerebral 
syphilis. 


Vfrican (black) 

\rmeman .... 
3utch and Flemish 
-English .... 
^>ench .... 
lerman .... 
Ireek .... 
Bebrew .... 
^rish ..... 
talian' .... 
Lithuanian .... 
Pacific Islander 
tloumanian .... 
Scandinavian » 

scotch .... 
Slavonic' .... 
Vlixed .... 

Total .... 


M. 

2 
1 
2 
22 
3 
4 

3 
5 
31 
7 
2 

2 
3 
1 

2 


F. 

31 
4 

7 
18 

3 

1 

2 
3 
2 
5 


T. 

2 

2 
53 
4 
g 

3 
12 
49 
10 
2 
1 
2 
5 
4 
3 
7 


M. F. T. 

1 - 1 
1 - 1 


M. F. T 
- 1 1 


M. F. T. 

- 1 1 

1 - 1 

1 - 1 
4 15 


M. F. T. 

2-2 

1 - 1 
6 2 8 
1 - 1 

2-2 
1 1 2 
9-9 

2-2 


M. F. T. 
2 1 3 


91 


77 


168 


2-2 


- 1 1 


7 2 9 


24 4 28 


2 1 3 


Table 7. Race of First Admissions Classified with Reference to Principal 
Psychoses — Continued. 


Racx. 


With 
Huntington's 
chorea. 


With brain 
tumor. 


With other 
brain or 
nervous 
diseases. 


Alcoholic. 


Due to drugs 
and other 
exogenous 
toxins. 


With 
pellagra. 


African (black) .... 

Armenian 

Dutch and Flemish 

l<Inglii>>i ..... 

['Vench 

lerman 

jreek ..... 

3ebrew 

[riah 

Italian > 

Lithuanian .... 
Pacific Islander .... 
Roumanian .... 
Scandinavian* .... 
Scotch ..... 

Slavonic * 

Mixed 


M. F. T. 


M. F. T. 

- 1 1 

- 1 1 

1 - 1 


M. F. T. 

3-3 

- 1 1 

- 1 1 
1 - 1 

- 1 1 
3 1 4 

- 1 1 


M. F. T. 

1 - 1 

1 1 2 
1 - 1 


M. F. T. 


M. F. T. 


Total 




1 2 3 


7 5 12 


4 1 5 







1 Includes "North" and "South." 
* Norwegians, Danes and Swedes. 

1 Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovlnian. Mootenegrin, Moravian, Polish, Russian, Ruthe- 
oian, Servian, Slovak, Slovenian. 



42 P.D. 137 



Table 7. Race of First Admissions Classified with Reference to Principal 
Psychoses — Continued. 



Raci. 


With other 
somatic 
diseases. 


Manic- 
depressive. 


Involution 
melan- 
cholia. 


Dementia 
praecox. 


Paranoia 

and 
paranoid 
conditions. 


Epileptic 
psychoses. 


African (black) .... 

Armenian 

Dutch and Flemish 

English 

French 

German 

Greek 

Hebrew 

Irish 

Italian' 

Lithuanian .... 
Pacific Islander .... 
Roumanian .... 
S<»ndinavian ' .... 

Scotch 

Slavonic ' 

Mixed 

Total 


M. F. T. 

- 5 5 

- 1 1 

- 1 1 

- 6 6 
1 - 1 

- 1 1 

- 1 1 

- 1 1 


M. F. T. 

- 7 7 

1 2 .3 
1 3 4 
1 1 2 

2-2 

- 1 1 

- 1 1 


M. F. T. 

1 - 1 


M. F. T. 

4 5 9 

1 - 1 

2 1 3 

2-2 
8 3 11 
1 2 3 

1 2 3 


M. F. T. 
1 1 2 


M. F. T. 


1 16 17 


5 15 20 


1 - 1 


19 13 32 


2 1 3 


1 - 1 



Table 7. Race of First Admissio7is Classified with Reference to Principal 
Psychoses — Concluded. 



Race. 


Psycho- 
neilroeea 

and 
neuroses. 


With 
psycho- 
pathic 
personality. 


With 
mental 
deficiency. 


Un- 
diagnosed 
psychoses. 


Without 
psychosis. 




M. F. 


T. 


M. F. T. 


M. F. T. 


M. 


F. 


T. 


M. F. T. 


African (black) 


















Armenian .... 


















Dutch and Flemish . 










1 




1 




English 


1 


1 






3 


7 


10 




French 










1 




1 




German 


















Greek 


















Hebrew 












2 


2 




Irish 


1 


1 


1 1 




3 


1 


4 




Italian! . . '. 










3 




3 




Lithuanian .... 










1 




1 




Pacific Islander 












1 


1 




Roumanian .... 


















Scandinavian * 










1 


1 


2 




Scotch 












1 


1 




Slavonic' .... 


















Mixed 








1 - 1 










Total .... 


1 2 


3 


1 1 


1 - 1 


13 


13 


26 





» Includes "North" and "South." 
» Norwegians, Danes and Swedes. 

» Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, Russian, Ruthe- 
nian, Servian, Slovak, Slovenian. 



P.D. 137 43 

Table S. Age of First Admissions Classified with Reference to Principal 

Psychmes. 



Pbtchoses. 


Total. 


Under 
15 years. 


15-19 
years. 


20-24 
years. 


25-29 
years. 




w 

M. 


r ■ 


T 


w 
M. 


F. T. 


M 
M. 


r . 


T 


w 
M. 


r . 


1 . 


M. 


r . 


T 


1. Treumatic . 






9 
L 




_ 


_ 








1 
1 




1 








2. Senile 




7 
I 


1 


























3. With cerebral arterioscicroiiis 


7 


2 


9 


























4. General paralysia . 


OA 


4 


OB 


I 


_ 


1 


1 




1 








1 


~ 


1 


5. With cerebral syphilis .... 

6. With Huntington's chorea . 


2 




3 
















J 


1 
1 






































7. With brain tumor .... 


1 





o 
o 


























8. With other brain or ner>-ou8 diseases 


7 


e 





I 




1 




1 


1 














9. Alcoholic 


A 
\ 


1 





























10. Due to drugs and other exogenous toxins 
































11. With pellagra 
































12. With other somatic diseases 


1 


16 


17 
















1 


1 


- 


3 


3 


13. Manic-depressive .... 


5 


15 


20 








1 


2 


3 


1 


3 


4 




2 


2 


14. Involution melancholia 


1 




1 


























15. Dementia praecox 


19 


13 


32 


2 




2 


3 


3 


6 


5 


4 


9 


3 


3 


6 


16. Paranoia and paranoid conditions 


2 


1 


3 


























17. Epileptic psychoses .... 


1 




1 














1 




1 








18. Psychoneuroses and neuroses 


1 


2 


3 




1 


1 


1 


1 


2 














19. With psychopathic personality 




1 


1 


























20. With mental deficiency 


1 




1 




















1 






21. Undiagnosed psychoses 


13 


13 


26 














4 


2 


6 


1 


3 


4 


22. Without psychoeis .... 
































ToUl 


91 


77 


168 


4 


1 


5 


6 


7 


13 


12 


11 


23 


6 


11 


17 



Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses — Continued. 



Pbtchoses. 


30-34 
years. 


35-39 
years. 


40-44 
years. 


45-49 
years. 


50-54 
years. 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T, 


M. 


F. 


T. 


1. Traumatic ... 
































2. Senile .... 
































3. With cerebral arteriosclerosis 




















1 




2 








4. General paralysis 


5 


1 


6 


6 


1 


7 


2 




2 


3 


2 


5 


3 




3 


5. With cerebral syphilis 


1 




1 


























6. With Huntington's chorea .... 
































7. With brain tumor 


























1 


1 


2 


8. With other brain or nervous diseases . 


1 




1 


1 




2 




2 


2 


2 




2 


2 


1 


3 


9. Alcoholic 


1 






1 
























10. Due to drugs and other exogenous toxins 
































11. With pellagra 
































12. With other somatic diseases 


1 


3 


4 




4 


4 




1 


1 




1 


1 




1 


1 


13. Manic-depressive 




1 


1 




3 


3 


1 


1 


2 


1 




1 




2 


2 


14. Involution melancholia 
































15. Dementia praecox 


5 


1 


6 




1 


1 


1 




1 




1 


1 








16. Paranoia and paranoid conditions 

17. Epileptic psycooses 


1 




1 








1 




1 










1 


1 
































18. Psychoneurows and neuroses 
































19. With psychopathic personality 






















1 


1 








20. With mental deficiency 
































21. Undiagnosed psychoses 

22. Without psychosis 


1 


1 


2 




2 


2 


I 


2 


3 


4 




4 


1 




2 
































Total ... 


16 


7 


23 


8 


12 


20 


6 





12 


11 




17 


7 


7 


14 



44 



Table 8. 



Age of First Admissions Classified with Reference to Prindpal 
Psychoses — Concluded. 



PSTCHOSBS. 



55-59 
years. 



60-64 
years. 



Traumatic 

Senile . . . ' ' ' 
With cerebral arteriosclerosis 
General paralysis 
With cerebral syphilis 
With Huntington's chorea 
With brain tumor 

With other brain or nervous diseases 

Alcoholic ..... 

Due to drugs and other exogenous toxins 

With pellagra 

With other somatic diseases 
Manic-depressive . . ' ' 
Involution melancholia 
Dementia praecox ■ . . . 
Paranoia and paranoid conditions 
Epileptic psychoses . . . .* 
Psychoneuroses and neuroses 
With psychopathic personality .' 
With mental deficiency 
Undiagnosed psychoses . '. 
Without psychosis 



M. F. T. 



1 - 

2 - 
1 - 



M. F. T. 



1 1 



Total 



10 



1 1 



70 years 
and over. 



M. F. T. 

1 - 1 



- 3 



1 2 



M. F. T. 



Unascer- 
tained. 



M. F. T. 



1 1 



46 P.D. 13V 

Table 10. Environment of First Admissions Classified with Reference to 
Principal Psijchoses. 



PSTCHOSBS. 



Total. 



1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis .... 

5. With cerebral syphilis 

6. With Huntington's chorea . 

7. With brain tumor .... 

8. With other brain or nervous diseases 

9. .\Icoholic ...... 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive .... 

14. Involution melancholia 

15. Dementia praecox .... 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses .... 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psychosis .... 



Total 



91 



77 



168 



Urban. 



74 163 



Rural. 



M. F. T. 



Unascer- 
tained. 



M. F. T. 



1 1 



1 1 



Table 11. Economic Condition of First Admissions Classified with 
Reference to Principal Psychoses. 



Psychoses. 



Traumatic 

Senile .... 
With cerebral arteriosclerosis 
General paralysis 
With cerebral syphilis 
With Huntington's ^horea . 
With brain tumor 
With other brain or nervous dis- 



Alcoholic .... 
Due to drugs and other exogenous 

toxins .... 
With pellagra . . 
With other somatic diseases 
Manic-depressive ' 
Involution melancholia 
Dementia praecox 
Paranoia and paranoid conditions 
Epileptic psychoses 
Psychoneuroses and neuroses 
With psychopathic personality 
With mental deficiency 
Undiagnosed psychoses 
Without psychosis 

Total .... 



Total. 



Dependent. 



Marginal. 



Com- 
fortable. 



Unascer- 
tained. 



77 



15 



17 
20 
1 

13 32 
1 3 



90 75 165 



M. F. T. 



P.D. 137 47 

Table 12. Use of Alcohol hy First Adiiiissions Classified icith Reference to 
Principal Psychoses. 



P8TCH08E8. 


Total. 


Abstinent. 


Temperate. 


Intem- 
perate. 


Unascer- 
tained. 





M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. 


T. 


M. F. T. 


1. Traumatic . . 


2 


_ 


2 


1 


_ 


1 


_ 


_ 


_ 


1 - 


1 


_ _ _ 


2. Senile 




1 


1 






1 














3. With cerebral arterioecleroeis 


7 


2 


g 




2 


2 


6 


_ 


6 


1 


1 


_ _ _ 


4. General paralysis . 


24 


4 


28 


14 


4 


18 


9 


_ 


9 
1 


1 - 


1 




5. With cerebral syphilis 


2 


1 


3 




1 


1 


1 


_ 


1 


1 


_ _ - 


6. With Huntington's chorea . 




















1 - 






7. With brain tumor 


1 


2 


3 




2 


2 


_ 


_ 


_ 


1 


_ _ _ 


8. With other brain or nervous dis- 


























eases 


7 


5 


12 


3 


5 


8 


3 


_ 


3 


1 - 


1 


_ _ _ 


9. Alcoholic ..... 


4 


1 


5 














4 1 


5 


_ _ _ 


10. Due to drugs and other exogenous 


























toxins ..... 


























11. With pellagra .... 


























12. With other somatic diseases 


1 


16 


17 




15 


15 


1 


1 


2 








[3. Manic-depressive 


5 


15 


20 


3 


14 


17 


2 


1 


3 








14. Involut'on melancholia 


1 










1 














15. Oementia praecox 


19 


13 


32 


14 


12 


26 


4 




4 


1 - 


1 


1 1 


16. Paranoia and paranoid conditions 


2 


1 


3 




1 


2 


1 












17. Epileptic psychoses 






1 






1 














18. Psychoneuroees and neuroses 




2 


3 




2 


3 














19. With psychopathic personality 




1 


1 




1 


1 














20. With mental deficiency 


1 




1 


1 




1 














21. Undiagnosed psychoses 


13 


13 


26 


5 


12 


17 


2 


1 


3 


6 - 


6 




22. Without psychosis 


























Total 


91 


77 


168 


45 


72 


117 


29 


3 


32 


17 1 


18 


- 1 1 



48 



P.D. 13 



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^ ^ c. . 



K O 



>, 



- c o _ 

. «i X £ ^ 5--"oT.i 
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P.D. 13: 



49 



Table 14. Psychoses of Readtnissions. 

Psychoses. Males. Females. 



1. Tr 



'i' p-ych().>»es .... 
S. '<-<es ..... 

I' 1 1 h cerebral arteriosclerosis . 

(. I'vsLs ... 

r th cerebral -syphilis 

]' ith Hiintington'.s chorea 

}' n h brain tumor .... 

]' . t h other brain or nervous diseases 

.\ > ( hoses ..... 

r-> . n..-. line to druffs and other exogenous toxin- 
Psy<'hose8 with pellagra .... 
P>*y ( hoses with other somatic diseases 
Manic-depressive psychoses 
Involution melancholia 
Dementia praecox 
Paranoia and paranoid conditions . 
Epileptic psychoses 
Psychoncuroses and neuroiies 
Psychoses with psychopathic personality 
Psychoses with mental deficiency . 
rndiagnosed psy-choses 

Without psychosis ..... 



Total 



13 



Total. 



19 



T.\BLE 15. Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge. 



Psychoses. 



Total. 



Recovered. 



Improved. 



Unimproved. 



1. Traumatic ... 

2. S«'nile .... 

3. With cerebral arteriosclerosis 

4. General paralysis 
.5. With cerebral .syphilis 

6. With Hunlington's chorea 

7. With brain tumor 

8. With other brain or nervous 

diseases 

9. -\lcoholic . 
10 Due to drugs and other exog 

enous toxins . 

11. With p' lhtpra 

12. ^^ 1 ■ diseases 

13. n; 

14. li, holia 

15. Dcnicniia pratcox 

16. Paranoia and paranoid condi 

tion'J 

17. K; vf-hoses 

18. 1' ~<-s and neuroses 

19. \\ 'pathic person 

alily 

20 With mental deficiency 

21- Undiagnosed psychoses 

22. Without pii>'cnotiis 

Total 



38 22 



T. M 



60 



T. 



M. 



T. 



34 19 53 



1 1 



50 



P.D. 137 



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.D. 137 



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P.D. 13^ 



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'ublic Document 



No. 137 



gJlie (ilommanuifalth of Masaatiftxastta 



ANNUAL REPORT 

OP 

THE TRUSTEES 

OF THE 

Boston Psychopathic 
Hospital 

FOR THE 

YEAR ENDING NOVEMBER 30, 1929 



Department of Mental Diseases 




PUBUCATION or THIS DOCUMENT APPROVED BY THE COMMIIWION OM ADMINIOTRATIOK AWD FINANCE 

W (.—'30. Order 9478. 

OCCUPATIONAL PRINTINO PLANT 
DEPARTMENT OF MENTAL OISKASC8 
OARDNKN STATK COLONY 
OANONKR. MASS. 



BOARD OF TRUSTEES. 
William Healy, M.D., Chairman, Boston. 
Mrs. Esther M. Andrews, Secretary, Brookline. 
Carrie I. Felch, M.D., B©§ton. ^ i i^ff^J 
Channing Frothingham, M.D., Boston. 
Allan W. Rowe, Ph.D., Boston. 
William J. Sullivan, Boston. V[i^^ /jyo 

Charles F. Rowley, Boston. 

CONSULTING PHYSICIANS. 
E. B. GooDALL, M.D., Ophthalmologist. 
G. Philip Grabfield, M.D., Internist. 
William F. Knowles, M.D., Oto-Laryngologist. 
Abraham Myerson, M.D., Neurologist. 

E. B. Sheehan, M.D., Gynecologist. 

The staffs of adjoining hospitals. 

OFFICERS OF THE HOSPITAL. 
C. Macfie Campbell, M.D., Medical Director. 
Arthur N. Ball, M.D., Chief Executive Officer. 
Karl M. Bowman, M.D., Chief Medieal Officer. 
Gaylord p. Coon, M.D., Senior Physician. 
G. Philip Grabfield, M.D., Senior Physician. 
John P. Powers, M.D., Senior Physician. 
Oscar J. Raeder, M.D., Senior Physician. 
Harry C. Solomon, M.D., Senior Physician. 
Samuel H. Epstein, M.D., Assistant Physician. 
Douglas Noble, M.D., Assistant Physician. 
Gilbert J. Rich, M.D., Assistant Physician. 
William C. M. Scott, M.D., Assistant Physician. 
Paul E. Tivnan, M.D., Assistant Physician. 
Helen C. Coyle, M.D., Medical Interne. 
Robert Gumming, M.D., Medical Interne. 
Frank J. Curran, M.D., Medical Interne. 
Geoffrey N. Paterson-Smyth, M.D., Medical Interne. 
Leon J. Saul, M.D., Medical Interne. 

, Chief of Neuropathological Laboratory. 

^Marjorie "Fulstow, M.D., Acting Chief of Neuropathological Laboratory. 
Whitman K. Coffin, M.D., Roentgenologist. 
Peter J. Dalton, D.M.D., Dentist. 

F. L. Wells, Ph.D., Head Psychologist. 

Mary Fitzgerald, Principal of School of Nursing. 

Esther C. Cook, Head Sodal Worker. 

Ethelwyn F. Humphrey, Head Occupaiicnal Therapist. 

Mrs. Elveretta Blake, Librarian. 

Elizabeth Libber, Treasurer. 

iBy arrangement with the- Department of Mental Diseases. 



CONTENTS. page 

Report of Trustees .......... 3 

Report of Medical Director ......... 3 

Report of Out-Patient Department ....... 12 

Report of Chief Medical Officer 18 

Report of Biochemical Laboratory ....... 20 

Report of Psychological Laboratory ....... 21 

Report of Neuropathological Laboratory ...... 23 

Report of Department of Therapeutic Research ..... 23 

Report of Chief Executive Officer ........ 25 

Report of Social Service Department ....... 26 

Report of Superintendent of Nurses ....... 29 

Report of Department of Occupational Therapy ..... 30 



P.D. 137 

Publications 
Report of Treasurer 
Statistical Tables 



3 

31 
32 
33 



BOSTON PSYCHOPATHIC HOSPITAL 
REPORT OF THE TRUSTEES. 

To His Excellency the Governor and the Honorable Council: 

In this report for the year 1929 we again wish to record our great satisfaction 
with the administration and the practical work for patients of the Boston 
Psychopathic Hospital. The remarkably efficient administration is due to a 
happy combination of central management on the part of the Department of 
Mental Diseases and the fine spirit shown by members of the hospital staff. 

The great value of the hospital for many varieties of patients is the result of 
the whole-hearted approach of physicians, psychologists, nurses, social workers, 
laboratory assistants and other members of the personnel to the difficult problems 
with which they deal co-operatively in their different departmental fields. How 
closely knit and interdependent their efforts are is witnessed to in the separate 
reports of the chiefs of departments. 

The great service that this hospital is rendering to the Commonwealth in taking 
care of actually mentally diseased patients, in aiding the courts, in meeting school 
problems, and in efforts to prevent mental disease may be readily seen by even a 
glance at the statistical enumerations which, as given, are not too detailed to be 
of interest to everyone. 

In previous reports we have mentioned the fact that the standing of this 
hospital in the professional world, both in this country and abroad, is evidenced 
by the number and quality of the psychiatrists and others who present themselves 
for training. However, it should also be stated, and with sincere gratitude and 
appreciation, that the upstanding position of the hospital has attracted very 
considerable grants from one of the great Foundations and from other special 
sources, all of which are named in the report, for carrying on particular pieces of 
research of importance in the field of psychiatry. 

The Medical Director's own report herewith presented is nothing short of a 
brilliant monograph on the ramifications of modern psychiatry. We welcome its 
publication here and bespeak for it a wide reading. 

As citizens frequently viewing the practical working aspects of the hospifal we 
have found during the year remarkably little to criticize and that mainly concerned 
with the physical conditions of the hospital which we feel before long must have 
extensive repairs. And once more we take occasion to express not only our 
satisfaction but also our thankfulness for the splendid co-operative spirit which 
is continually shown on all sides and which, more than anything else, makes for 
a smooth-running hospital and intelligent service to the patients. 

Respectfully submitted, 

William Healy, Chairman. Carrie Innes Felch. 

Esther M. Andrews, Secretary, Channing Frothixgham. 

Allan Winter Rowe. Charles F. Rowley. 
William J. Sullivan. 

MEDICAL DIRECTOR'S REPORT. 

December 12, 1929, 
To the Board of Trustees of the Boston Psychopathic Hospital. 

In accordance with the provision of the statutes I submit for your considera- 
tion the report for the statistical year ending September 30. 1929. and for the 
Sscal year ending November 30, 1929. 



On the General Organization of the Work. 
The hospital during the past year has continued to carry on its three main 



4 



P.D. 137 



functions of caring for the mentally and nervously disordered, of carrying on 
continuous research into the causation and treatment of this special form of 
illness and of being a training centre for a great variety of workers in this special 
field — medical graduates, medical students, affiliated nurses, occupational 
therapists, social service workers, psychologists and laboratory technicians. These 
main functions are so closely interrelated that any interference with the one 
would have a serious effect upon the efficiency of the other.. The fundamental 
test of the hospital is the care and treatment of the individual patient, but 
satisfactory treatment of the individual sick person is only possible when there 
is in addition to the good will, sympathy and the conscience of the individual 
physician a keen interest in the special medical problems presented by the indi- 
vidual case, not only an interest in recognizing what is familiar in the disorder 
but curiosity as to the significance of what is unfamiliar and eagerness in the 
systematic investigation of what is still obscure. For the sick person to receive 
the very best care which is available there must be on the part of each member 
of the staff the attitude of the a'.ert investigator as well as of the kindly physician. 
Active curiosity as to the real significance of the symptoms of the sick patient 
and as to the mechanisms which may underly these symptoms means the close 
co-operation of the physician on the ward with the physician in the laboratory; 
the latter applies special procedures in order to test the functions of the individual 
systems and organs to see whether the key to the complex human disorder may 
not be found in a disorder of the digestive apparatus, in some subtle bacterial 
infection, in some disturbance of the composition of the blood, in imperfect function- 
ing of liver or kidney, in the disturbed activity of those organs which have so 
much to do with our energy and our emotions, the endocrine glands. The physician 
must have not only an enlightened curiosity as to the actual functioning of each 
part of the complicated machinery which makes up the bodily household; he 
must be also curious as to the way in which the patient as an individual reacts 
to his life situation, ruminates over his past, daydreams about the future, and 
constructs the world in the light of his own individual needs and underlying 
emotions. In order to know the individual patient he must establish a human 
bond between himself and the patient and as, with many patients to care for, he 
can only give a moderate portion of his time to each individual patient, he must 
utilize the observations which the nurses make in their more continuous and 
intimate contacts with the patient. The value of the observations of the nurses 
will be in proportion to the insight which the nurses have into the special problems 
of the individual patient, and for such insight the nurse is dependent upon the 
physician who is looking after the patient. For the care of the patient, therefore, 
it is of the greatest importance that the physician should give the nurse an ade- 
quate statement as to the special needs and problems of the individual patient; 
in return he will receive from the nurse a much more valuable and relevant series 
of observations which will usefully supplement the results of his own personal 
contact with the patient. In the treatment of the patient the physician requires 
the cooperation of various workers. For the bedside nursing, for the sympathetic 
human atmosphere, for the opportunity of the patient to talk about disturbing 
preoccupations and to get helpful reassurance the physician needs the collaboration 
of the nurse. In many cases, however, there is needed in addition the healthy 
utilization of unemployed energy and of dormant or latent skills, with the satis- 
faction which opportunities for occupation offer. The physician turns to the 
occupational therapist to create an atmosphere of healthful constructive activity, 
to offer to the sick person a choice of various occupations, one of which may 
arouse interest and be a source of much satisfaction; the occupational therapist 
encourages the patient to take up some suitable activity, no matter how simple 
or economically modest, emphasizes the value of accomplishment and through 
the feeling of success stimulates the patient to a fuller use of his or her endowment, 
so that less energy remains available for morbid preoccupations or disturbing 
activities. The physician aims not only to restore to normal functioning any 
disordered organ or system of the body, and with the help of nurse and occu- 
pational therapist to deal with those disturbances of the emotional and intellectual 
life which can be treated by personal influence and encouragement, by the op- 



P.D. 137 



5 



portunity for emotional release in confidential interviews, by the influence of that 
intangible spirit which is so important in the atmosphere of the ward and in the 
department of occupational therapy; the physician aims to restore the patient to 
his normal place in the social environment, to help him to deal with the concrete 
tests involved in the relationship of the patient to wife or husband, to children 
or parent, to employer and to fellow-worker, to his or her social and religious 
group. The physician realizes that a nervous or mental disorder, where it is not 
symptomatic of some underlying organic process is an evasive or inferior way of 
meeting the actual demands of the life situation. He aims not only at restoring 
the physical health where it is at fault, and giving the patient opportunity for 
review and revaluation of all his personal problems, but also at giving the patient 
specific help in relation to taking up his or her definite problems in home, work- 
shop and social group. The study of the social situation is important; the 
resources that may be available to help the patient in dealing with the social 
situation, the special difficulties, the complex personalities involved, the actual 
economic trials have all to be carefully weighed. For this purpose the physician 
needs the cooperation of the social worker, skilled to investigate situations, 
familiar with the resources of the community, able to help the patient by 
practical suggestion to take the first steps towards the return to full social and 
economic efficiency. Without the help of the social worker the critical period of 
convalescence and of return to normal social life would be very much more dif- 
ficult for the individual patient. With the assistance of the social worker it is 
possible to discharge the patient from the hospital at an earlier date than would 
otherwise be possible and to maintain in the community as productive members 
vulnerable individuals who, without some such contact, would be much more 
liable to fall by the way. 

In the task of studying the breakdown of the individual in face of the stresses 
and strains of life and of endeavoring to readjust the individual to the life 
situation with full appreciation of his personal assets and liabilities, the cooper- 
ation of the psychologist is of value. In many cases the psychologist is able to 
give a useful decision as to the intelligence of the individual and his suitability 
for economic tasks of greater or less complexity. He is able to make a study of 
the specific abilities and disabilities of the patient and make much more precise 
the lines along which success can be foreseen or failure avoided. He can bring 
to the study of the emotional life and of the total personality a much more rigid 
technique and much more precise formulations than the clinical psychiatrist 
would otherwise have. 

An essential condition for the smooth and efficient working of each department 
and for the best cooperation between these various departments is an efficient 
central executive. The work of a hospital is not altogether of a detached pro- 
fessional nature. The care and treatment of patients requires the careful organ- 
ization of supplies and the supervision of all the services which are essential to 
the physical comfort of the patients and those working in the hospital. The 
conditions under which patients are admitted to and discharged from the hospital 
have to be scrutinized in a careful way, as in many cases authority is required 
for detaining the patient in the hospital when his disorder makes him unwilling 
to accept the recommendation of his physicians. The cooperation of relatives is 
frequently required in order that the necessary steps be taken to safeguard the 
patient from danger and to insure for him the necessary hospital care. The 
executive officers, therefore, have not only the fundamental problems of arranging 
for the actual running of the hospital and organizing various services; they have 
also the task of making all necessary arrangements for the admission and dis- 
charge of patients and for interpreting to distressed relatives the meaning of the 
necessary arrangements, and helping to give them a saner and more modern 
attitude towards the sickness of their relatives. A fascinating study of contem- 
porary thought and beliefs with regard to mental disorder might be made on the 
basis of the conversations which take place in the office of the executive officer. 
With the work of the hospital specialized in various departments, with the e.x- 
ecutive group, the clinical group, the laboratory group, the ancillary medical 
iervices and the domestic services there is obvious need of a spirit of helpful 



6 



P.D. 137 



cooperation which makes the system workable and prevents the numerous joints 
from creaking too badly. It is a pleasure to express one's appreciation of the 
helpful spirit of cooperation which is so general throughout the hospital and 
which makes it such a pleasant place in which to work. 

On the Nature of the Work. 
First in order comes the care and treatment of the patients who are admitted 
to the hospital for study and treatment in the wards or who come to the Out- 
Patient Department for advice while still able to carry on at home or at work. 
The average citizen is beginning to realize that mental disorders are not so 
different from other forms of sickness as had been usually supposed. He is 
slowly divesting himself of the fear which, for centuries, had been associated 
with mental disorders. He realizes that in a mental hospital many of the 
patients have disorders which might also be treated in the general hospital if the 
staff of the general hospital should be interested in these problems and should 
have a psychiatrist as one of the members of the staff. Whether a patient is 
treated in a general hospital or in a psychopathic hospital is a question often 
determined by incid^tal facts of structure and of personnel. Steady progress is 
being made in dissolving the artificial barriers which separate so-called mental 
disorders from the other ailments to which human flesh is heir. Some idea of the 
actual material which is dealt with in the Boston Psychopathic Hospital may be 
gained from a few brief summaries of cases. 

Mental Disorders Symptomatic of Bodily Ailments. 
In the first few cases one sees that the disturbed behaviour, grasp of the 
environment, appreciation of social values, are but indications of a well marked 
bodily ailment. The first two cases illustrate the disturbances that may be as- 
sociated with some of the complications following childbirth. Such disturbances 
following childbirth are not uncommon and at the Boston Psychopathic Hospital 
a large number of such patients are admitted. There is no group of cases for 
which the Psychopathic Hospital is more specially adapted than these mothers 
who, owing to some complications of the lying-in period, develop symptoms dif- 
ficult to care for in a general hospital but often transitory. They can often be 
kept in the Psychopathic Hospital until their full recovery. 

A. B., a woman Qf 31, eight days after she had been delivered by Caesarean 
section in another hospital became delirious and too difficult to care for. She was 
admitted to the Boston Psychopathic Hospital in a delirious condition with fever 
due to a uterine infection. During the next six weeks, during which the treatment 
was supervised by the consulting gynecologist, the patient's physical condition 
gradually became normal. A review of the whole situation disclosed the fact that 
the patient had been brooding over certain conditions associated with her marriage 
and had looked forward with dread to childbirth. The patient was transferred 
to a state hospital for convalescent treatment. 

B. C., a colored woman of 22, was admitted to the hospital three months after 
the birth of a child. The childbirth had been followed by an infection and later 
by weakness of the legs. While being treated at the City Hospital she became 
delirious and was transferred to the Psychopathic Hospital. Treatment was 
directed to the uterine infection, to the muscular condition and to pellagrous 
symptoms, in cooperation with the consulting gynecologist and neurologist. The 
patient has made a complete recovery from the mental confusion and her general 
physical condition has steadily improved. 

CD., a man of 70, a few days before admission to the hospital became con- 
fused, felt that he was being imprisoned and would soon be foully murdered. 
When examined at the hospital he was found to have a failing heart and very 
high blood pressure. The mental symptoms indicated malnutrition of the brain, 
secondary to the cardio-vascular conditions. The treatment of this case was the 
protracted treatment necessary for heart symptoms of this nature, and after 5 
months the patient left the hospital with his circulation in much better condition; 
his mental symptoms had completely disappeared. 



P.D. 137 



7 



D. E., a man of 31, was admitted to the hospital because he had suddenly de- 
veloped the idea that the people next door were trying to annoy him, called him 
bad names, leveled all manner of abuse against him. These symptoms were the 
expression of the malnutrition of the brain due to pernicious anaemia, and 
treatment for this condition was at once instituted. He had on two previous 
occasions had similar mental symptoms when the anaemia had reached a certain 
degree of severity. 

Disorders of Conduct (Delinquency), Symptomatic of Bodily Ailments. 

E. F., a man of 59, was found guilty of attempting to defraud an insurance 
company by trying to set fire to his apartment. The patient was referred by 
the court to the Psychopathic Hospital for examination. It was found that he 
had definite deterioration of the mental functions secondary to diseased blood 
vessels in the brain. Owing to the discernment of the judge this patient is now 
receiving treatment in a mental hospital instead of being relegated to a penal 
institution. 

F. G., a negro boy of 17, was arrested on a charge of indecent assault on a little 
girl. The facial expression of the lad and the tremor of his hands impressed the 
court and he was sent to the Psychopathic Hospital for examination. His con- 
dition was found to be the result of an attack of epidemic encephalitis ("sleeping 
sickness") from which he had suffered 4 years previously. He is now being 
treated in a mental hospital. 

G. H., a man of 24, is a similar case. For several years he had had many court 
records and had been a somewhat disturbing inmate at home. His admission to 
the Psychopathic Hospital followed arrest for certain sexual irregularities. He, 
too, was found to present the residuals from an old attack of lethargic encephalitis. 

H. I., a boy of 12, had for over a year been lagging behind in school and had 
commenced to steal and to lie without shame. A partial paralysis of the left arm 
and leg developed. The diagnosis of lethargic encephalitis was made. In such a 
case the boy is liable to be treated as a purely pedagogic or ethical problem. 
The steady increase among teachers of interest in and knowledge of mental hygiene 
makes them ever more sensitive to the possibility that the behaviour of the 
child may be explained t^y underlying factors which can only be determined by a 
thorough medical or psychiatric review. The dissemination of such knowledge 
the teaching profession means that children who throughout require help are 
seen at a much earlier age than before and that situations are dealt with in a 
much more appropriate manner. 

In the above cases the diagnosis of a recognized type of disorder, lethargic 
encephalitis, made the situation clearer and gave the key to the correct manage- 
ment of the problem. In other cases the underlying condition may not be so 
familiar or so easy to formulate and there may be more hesitation in accepting 
the disturbed conduct as the expression of some underlying physical ailment. 

Thus I. J., a girl of 20, had for 9 months previous to admission been careless in 
her work, promiscuous in her relations, lying and stealing. The patient had 
infected tonsils and gonorrhea, but what was more significant, she had gained 
40 pounds in the previous six months. This rapid development of obesity sug- 
gested the presence of some quite specific disturbance of the bodily mechanisms, 
but there was no evidence to make clear the exact nature of the underlying 
specific process. 

Disorders Based on Personality and on Environmental Influences. 

In other patients the disturbed behaviour does not seem to be the expression 
of any bodily ailment but to be the way in which an individual, with his own 
special type of personality, reacts to the actual life situation and to the special 
influences of the environment. A study of this material has suggestions of value 
in regard to the training of children and the attitude of parents towards children. 

J.K., a Jewish boy of 14, for 3 weeks before admission to the Psychopathic 
Hospital complained of being tired, of breathing with difficulty owing to a lump 
in his throat; he spoke as if he were hoarse, he frequently shrieked "I am dying" 
and screamed for his mother. The boy had been doing poorly in school for the 



8 P.D. 137 I 

past year. The mother was a very solicitous and emotional woman and whenever 
she had any difficulty with the boy she would cry and tear her hair. The boy's 
behaviour, to a large extent, reflected the behaviour of the mother and served as 
an appeal to the mother. In the treatment of this boy the important point was 
to place him in a healthy atmosphere where no undue emotional influences would 
foster the continuation of his nervous behaviour. He was, therefore, sent to a 
boy's camp after which he was admitted to a home for Jewish children. His 
nervous symptoms have completely disappeared. The father reports to the 
Social Service Department about the progress of the boy and an endeavor has 
been made to help the mother to develop a better attitude so that the three other 
children remaining at home may not be infected by her emotional reactions. 

K.L., a boy of 9, for the past year had been running away from home, sleeping 
in doorways, going without meals, associating with perverts, worrying over his 
own bad habits. The behaviour seemed to be the reaction to a sordid home with 
an incapable mother, rather than the expression of any inner difficulties due to a 
seriously ill-balanced constitution. The transfer of the boy to a foster home 
caused a marked change for the better in his behaviour. Attention to the boy at 
this period may mean the development of a normal adult while the continuation 
of the previous neglect favors the development of a career of delinquency and 
disease. 

L.M., a boy of 14, for 3 months had been unable to concentrate on his school 
work, had suffered from headache and been fearful of the dark. Rumination over 
sex matters, a feeling of inferiority, inadequate recreation and worry over the 
financial difficulties of the household seemed to explain the development of the 
condition. After a month of life in a camp with some frank talks in regard to 
sex the nervous symptoms had disappeared. 

M.N., a boy of 16, ran away from an unhappy home, drifted along, contracted 
syphilis. In his despair he tried to hang himself. After a review of the case he 
was admitted to a state school, is receiving the training appropriate to his en- 
dowment while being treated for syphilis. 

N.O., a girl of 16, possibly somewhat unstable constitutionally and subject to 
violent temper tantrums, had after her mother's death been brought up in a 
somewhat unfortunate atmosphere under the influence of a father of doubtful 
standards. In a violent temper tantrum she attempted suicide and was brought 
to the hospital. She was a girl of excellent intelligence, able to discuss with the 
physician the problems of her own endowment and her life situation and to make 
reasonable plans for her own further development. On leaving the hospital she 
continued to keep in contact with the social worker and to report at intervals to 
the Out-Patient Department. Her stability seems to be much improved. 

O.P., a girl of 16, was brought to the hospital after a suicidal attempt. All 
her life she had shown a somewhat impulsive unstable type of reaction. The 
home influences had been poor. The girl was of limited intelligence. In this she 
differed from the previous patient who was well enough endowed to be able to 
take the initiative in making her own plans and to deal with her problems with 
fair realization of the issues involved. In the present case with a girl of limited 
intelligence, brought up in a broken home of somewhat uncertain influence, with 
no family circle able to give her consistent moral guidance or material assistance 
one looks around to see what social resources are available for dealing with the 
patient. The social side of the case is of importance. If ignored by the community 
the later evolution of the patient may lead her into an irregular sex life with the 
attendant complications of venereal disease. Without some support from the 
community the probability that she will develop a mental condition and require 
care in a hospital is considerable. Systematic help given to a girl at this period 
may involve the time of skilled workers and considerable expense but this 
expenditure may be an economical investment for the community. 

P.Q., a girl of 15, for 2 years had been listless, absent-minded, daydreaming 
and tearful; sensitive to criticism, she would frequently remain away from school. 
From an early age she had tantrums of temper and she was of somewhat limited 
intelligence. Her parents had been very solicitous and much of the patient's 
behaviour seemed to represent an appeal for sympathy to her solicitous parents 



P.D. 137 



9 



who felt quite hopeless in regard to the management of such a problem. When 
the patient was in the hospital she had the benefit of a stable regime and the 
opportunity of discussing the significance of her reactions. At the same time it 
was possible to review with the parents the whole situation and to suggest to 
them the outlines of a more reasonable discipline for the patient. 

The above brief histories of patients admitted to the hospital represent only a 
few of the many types of disorder treated in the hospital. These few cases, how- 
ever, may suffice to give some idea of the comple.xities involved in the task and 
of the broad issues which are raised by the individual cases. The cases raise 
problems of internal medicine, problems with regard to infections, cardio-vascular 
and digestive disorders, gross disturbances of spinal cord and brain; they raise 
problems of the varied endowment of human nature and of the special degree and 
type of vulnerability of the individual; they raise questions of the moulding 
influences in the individual life, the influence of parents, brothers and sisters, of 
teachers, schoolmates and of the social group; they raise problems of the special 
abilities and disabilities in the occupational field and of the conditions of work 
which the patient has to meet; the cases raise problems of success and failure as 
measured by different standards; they raise questions of the organization of the 
community, and of the material and cultural satisfaction which is available to 
people of both sexes, of different ages, of different racial and religious origin, of 
different cultural levels. 

The case records, therefore, can be utilized for wider studies than those dealing 
with detailed mechanisms of physiological and psychological nature, they can be 
utilized for the study of important problems in human relations, for an analysis 
of the factors involved in marriage, in family relations, in social relations in general. 

On Research. 

It has been emphasized above that even in the clinical work of the phj-^ician 
on the wards the spirit of investigation must be active if the best work is to be 
done. The clinical field offers rich opportunity for detailed studies of the nature 
and course of many types of mental disorders, as well as of the origin and special 
significance of individual symptoms. For the intensive investigation of specific 
problems it is frequently necessary to make special arrangements in the wards 
and to utilize special laboratory procedures; in the reports from those in charge 
of the various laboratories the nature of the special investigative work that has 
been done in the past year is outlined. 

Dr. Grabfield in his report emphasizes the fact that during the past year the 
laboratory of internal medicine has been more intimately associated with the 
clinical study of the patients on the wards than had been the case in previous 
years. In addition he refers to the role which this laboratory plays in the special 
study of stuporous conditions undertaken by Dr. Solomon, a.nd in the study by 
Dr. Bowman of the reaction of agitated and depressed patients to the adminis- 
tration of amniotin and of the reaction of schizophrenic patients to treatment 
with parathyroid extract. 

Dr. Solomon has been enabled by means of a special grant to begin a thorough 
digest of the results of his treatment of cases of neurosyphilis for the past 15 years. 
In addition to the continuation of his work on neurosyphilis and to the critical 
analysis of his results, Dr. Solomon has made a series of interesting observations 
on the reaction of epileptic patients to dehydration and on that of stuporous 
patients to the inhalation of carbon dioxide, as well as on some details in the 
malarial paroxysms of cases under treatment for paresis. 

The report from the Psychological Laboratory mentions in brief compass a 
series of investigations concerning special methods for testing the more general 
and the more specific abilities of individuals, the correlation of many psy- 
chometric tests in frequent use, the special analysis of the difficulties of school 
children in learning to read and the special value of certain clinical tests. 

In the report from the Neuropathological Laboratory Dr. Fulstow refers to 
some of the cases which have come to autopsy during the past year. Owing to 
the inadequate technical assistance in Jthe laboratory it is not possible to work 
up in adequate detail the pathological material which comes from the Psy- 



10 



P.D. 137 



chopathic Hospital and from other state hospitals and until the personnel in the 
laborator>^ is increased the study of the finer structural changes in cases of mental 
disorders cannot be carried on as actively as the importance of the topic demands. 

In pre\ious annual reports reference has been made to a special piece of clinical 
and social investigation, dealing with that t^-pe of mental disorder which furnishes 
the largest proportion of the chronic patients in mental hospitals. This group of 
patients with the diagnosis of schizophrenia is especially characterized by the 
eccentric and bizarre nature of the patient's behaviour and utterances, which 
make him seem so alien to the normal individual. It is the queer and un- 
intelligible reactions of patients of this type which, to a large extent, impress 
the layman and many physicians with the unintelligibility of mental disorders. 
The problems of these cases are the central problems of psychiatry-, and in every 
psychiatric centre different aspects of the problem have been made the subject of 
investigation. Investigators have scrutinized the physical condition of patients 
to find some clue to the disorder; others have studied the original endowment 
of the patient to see whether the disorder might be the result of some consti- 
tutional law; others have studied those factors in the en\'ironment which have 
moulded the personality and which have subjected the patient to important 
stress and strain. With the aid of a grant from the Laura Spelman Rockefeller 
Memorial it has been possible to carry on during the past few years a statistical 
analysis of the records of cases of this type. Professor E. B. Wilson of the 
Harvard School of Public Health has continued to cooperate closely in this study. 
A few papers have already been published dealing with this research but the 
material will still furnish a program of several years duration. It may be of some 
interest to mention the topics which come up for scrutiny in this statistical 
analysis. The factors which are being scrutinized, as possibly relevant to the 
development of this disorder are — physical symptoms; en\-ironmental or social 
stresses and strains; early home influences i broken homes, relation of parents); 
influence of schoolmates; conditions of work and recreation; indulgence in alcohol; 
racial and religious affiliations; duration of residence in the United States; level 
of intelligence as indicated by standard tests; type of personality as analyzed 
according to a special psychiatric outline. 

The results from the study of many of these factors may be meagre but the 
whole investigation, besides promising to \*ield some results of value, has the 
additional benefit of making the analysis of new cases much more precise and 
better focused upon the main issues. 

On the Nursing Service, the Department of Occupational Therapy 
AND THE Social Service Department. 

In the early part of this report reference has been made to the importance of 
these ancillary' services and their coordination with the general medical work. 
The system by which affiliated nurses spend a period of their training in the 
Boston Psychopathic Hospital has continued to justify itself; the arrangement is 
of benefit to the Boston Psychopathic Hospital and it sends back to the general 
hospitals a group of nurses who have had some experience at first hand with the 
management of nervous and mental patients. The interest of these nurses, as a 
rule, is gratifying. They bring a certain freshness and enthusiasm into the wards 
which is tonic and beneficial; contact with the human diflSculties which pre- 
occupy the patients offer a challenge to their ingenuit>% somewhat different from 
that made by the symptoms which have confronted them in medical and surgical 
wards. The gradual infiltration of the nursing profession with nurses who have 
had first hand contact with the problems of mental nursing, and who have a 
wholesome attitude towards the facts of mental disorder, cannot but have an 
important influence in time on the whole of the nursing profession. 

In the Department of Occupational Therapy the work has been continued 
during the past year with the same high degree of excellence and evidence of 
ingenuity and thought which has characterized the department in pre\ious years. 
The structure and personnel available do not make it possible for the patients to 
have as long a daily period of work as one would like, but with the resources at 



P.D. 137 



11 



the command of the hospital an effort is made to create in the occupational 
workshops and in the wards an atmosphere of constructive activity. 

The problem of the mental hospital patient has a social aspect which is more in 
evidence than that of the ordinary hospital patient, for the mentjll disorder itself 
is often to be understood only in the light of the environment and life situation. 
The mental disorder, therefore, cannot be understood from the study of the 
isolated individual but requires to be supplemented by a careful survey of the 
situation in which the patient broke down. The patient has only made a satis- 
factory recovery when he is able to face the tests of outside life, and the situation 
which he has to meet may require careful scrutiny. In the analysis of the 
environmental factors which have led to the mental upset and in the supervision 
of the patient in his or her first steps towards resumption of normal life and 
activity the physician needs the assistance of the psychiatric social worker. 

During the past year the work of the Social Ser\-ice Department has continued 
to be arduous as more demands are made upon it than its limited personnel can 
meet even with the assistance of students in training. During the past year the 
special research project above referred to required the ser\ices of four additional 
social workers with whose help it was possible to make a study of the envi- 
ronmental factors in the selected group of cases more accurate than would 
otherwise have been the case. The pitfalls in psychiatric work are numerous 
and may be illustrated by the case of a patient who, during her psychosis, told 
of a dramatic experience in the life of a relative upon whom apparently she had 
patterned her own recent behaviour. Unfortunately, this proved a false clue to 
the behaviour of the patient for on a review of this case 2 years later in the 
course of the special research project it was found that the dramatic experience 
was a purely imaginative drama of a relative who had never existed. It is, 
therefore, of very great value to hav« statements as to home and occupational 
situations checked up in detail by competent psychiatric social workers. 

On the Out-Patient Department. 

While the main emphasis of the hospital work is laid on the patients who are 
admitted to the wards for study and treatment, the Out-Patient Department 
plays a verj' important role in regard to the health of the community in general. 
It is perhaps through contact with the Out-Patient Department that the com- 
munity in general, the social worker, the medical student and the physician get 
the truest picture of modern psychiatry. In the Out-Patient Department the 
greatest variety of difficulties are dealt with, the one common factor being that 
for the study of the patients one must go beyond the review of the physical 
organs, and study the personality of the patient with due attention to the instincts 
and the emotions, the imagination and the intelligence, the special abilities and 
disabilities. In the Out-Patient Department the problems presented may be 
physical invalidism, marital incompatibility, delinquency, spells of the blues, 
diffuse or specific fears, nervous habits, difficulty in concentration, fear of in- 
sanity, worry over heredity, tantrums, night terrors, running away from home, 
lack of docility, difficulties in regard to the sexual life. The patients come from 
very varied sections of the community and come to the Boston Psychopathic 
Hospital through various channels. Some are referred by the numerous welfare 
organizations, some by physicians, others are referred by friendsor have heard 
in some lecture of the role of the hospital. The coordination of the work of 
the Out-Patient Department with other welfare organizations is a matter that 
requires mutual understanding and consideration, and compromise may some- 
times be necessary. Where a difficult child is found in the destitute home of a 
woman requiring care, it may not be easy to decide the respective role of the 
welfare worker, the district nurse, the mental hygiene supervisor, the psychi- 
atric social worker. Special attention is being given to this problem and a survey 
of the actual needs of the community, of the resources at present available and 
of the coordination of these resources will help to clarify the situation. 

In concluding I wish to express my appreciation of the good will and co- 
operative spirit of those who are associated with me in the work of the Boston 



12 



P.D. 137 



Psychopathic Hospital. The thanks of the staff are especially due to the 
consulting physicians who give so generously of their time and whose advice 
means so much to the resident staff. The smooth running of the hospital is a ! 
tribute to the efficiency and tact of the Chief Executive Officer whose relations 
with the other members of the staff make cooperation easy. The conscientious 
work and keen investigative interests of the members of the staff deserve to 
receive recognition. The members of the Board of Trustees have in the past 
year, as in previous years, been extremely cooperative and anxious to be of 
service whenever possible, and Dr. Kline, Commissioner of Mental Diseases has 
continued to show the same interest in maintaining the best standards and to 
give his support to all progressive work. 

Respectfully submitted, 

C. MACFIE CAMFBELL, Medical Director. 

REPORT OF THE OUT-PATIENT DEPARTMENT. 

To the Medical Director of the Boston Psychopathic Hospital: 

I herewith submit the report of the Out-Patient Department for the year ending 
November 30, 1929. 

The work of the Out-Patient Department has consisted of the examination and 
treatment of an average of eight patients a day. During the year, 1,049 new 
patients were examined alid it is with this group that this report is concerned. 

The patients may be divided into the following groups: 

A. Children: — 1. Feeblemindedness. 2. Conduct problems. 3. School problems. 
4. Cases for adoption. 5. Psychometric tests in special cases. 6. Vocational 
guidance. 

B. Adults: — 1. Feeblemindedness. 2. Nervous disease; functional and organic. 
3. Mental diseases, usually incipient. 4. Neurosyphilis. 5. Vocational guidance. 

C. Other Activities: — 1. Brookline School Clinic. 2. Teaching of special 
students in psychiatry, social service and psychiatric nursing. 

Feeblemindedness: In considering the problems of children feeblemindedness 
looms large, 151 cases. We shall return to this subject later. 

Conduct Problems: Physical, psychological and mental examinations have been 
made and advice based on psychiatric opinions has been fui'nished to courts, 
schools and social agencies. There were 77 of these cases of which 40 were fol- 
lowed by the clinic. Truancy, its causes and results, was studied in numerous 
cases. Whereas feeblemindedness is one of the most common causes of truancy, 
too high intelligence is sometimes a factor and more frequently special disabilities, 
such as inability to read. 

There were approximately 25 cases of non-readers among school children. The 
tutoring of nine of these cases has been supervised by Mr. R. A. Young of the 
Psychological Department. In other cases instructions and directions have been 
given parents a(nd teachers for helping these children. 

Problems due to m.ental complexes in children have been relatively few but 
these have been outstanding and among the more difficult cases to treat. 
Physical and economic difficulties to be overcome in the frequent visits necessary 
for this study are a serious factor. 

Feeblemindedness has been one of the most common problems, both in children 
and adults. Feeblemindedness is a factor in many cases of family difficulties. 
It oft(?n results in sex delinquency, with spread of venerea! disease and illegitimate 
pregnancy. Feeblemindedness, coupled with delinquency, furnishes many of the 
problems in the common terrain of criminal law and mental medicine. 

The demands for vocational guidance have become more common. Younger 
adults and adolescents have consulted the clinic on their own initiative; other 
adults have been referred by social agencies as an aid to their program. Un- 
fortunately, many of the older individuals referred for vocational guidance have 
been found feebleminded or nearly so and therefore unable to profit much from 
the results of the tests. 



P.D. 173 



13 



The social service of the clinic is one of its most valuable departments. The 
value of its follow-up work is substantial and far reaching and difficult to estimate. 
The Social Service Department alone has followed up 450 cases. Other social 
agencies have followed other cases in which the functions of the clinic have been 
only diagnostic and advisory. 

The work of the School Clinic Survey in the past two years has been in charge 
of Dr. Mary Palmer. This year's work is not yet complete. The work of last 
year was as follows: 



School Survey of Brookline Schools 192&-1929. 

School Clinic Staff: Dr. Mary Palmer, Psychiatrist; Mrs. Gertrude Pierce, 
Teacher; Miss Wilda Rosebrook, Psychologist; Miss Ethel A. Gleason, Social 
Worker. 

Baldwin . 
Cabot . 
Devotion 
DriscoU . 
Heath . 
Lawrence 
Lincoln . 



Names of Schools and Number of Students Referred. 

6 Longwood 
1 Parsons . 
9 Pierce 

7 Winthrop 
21 Runkle . 

9 Sewall . 
. 17 



Total 

Additional for school tests only 



1 
1 
24 

7 
35 
3 

141 
5 



Pupils in Survey first time .... 

Boys ... 59 Girls 
Pupils in previous Survey .... 

Boys ... 39 Girls 
Cases referred for Social Service Investigation 
Summary of Results from the point of view of the Intelligence Quotient 



30 
13 



I. Q. 

Boys 
9 



70 or below 
Girls 
4 



I. Q. 71 
Boys 
20 



146 
89 

52 

95 

- 80 

Girls 

13 



I. Q. 81 - 90 
Boys 
23 



Girls 



I. Q. 91 - 100 
Boys Girls 
30 . 13 



I. Q. 100 or Above 
Boys Girls 
14 5 



There is great need of vocational training opportunies for boys with I. Q. 
70 - 90. The girls can be referred to the Boston Trade School. The boys have 
only the Mechanics Arts course in high school which is too difficult for the lower 
I. Q.'s, i. e. the 70 - 80 group. 

On the basis of chronological age, using 6^ years in first grade, as a standard: 
50 students were 1 year retarded. 
54 students were 2 years retarded. 

17 students were 3 years retarded. 
4 students were 4 years retarded. 

Group showing retardation of 1 year: 

1 student had an I. Q. of 70 or below. 
8 students had an I. Q. of 71 - 80. 
11 students had an I. Q. of 81 - 90. 
10 students had an I. Q. of 100 or above. 

Group showing retardation of 2 years: 

1 student had an I. Q. of 70 or below. 

18 students had an I. Q. of 71 - 80. 

16 students had an I. Q. of 81 - 90. 

17 students had an I. Q. of 91 - 100. 



14 



P.D. 137 



Group showing retardation of 3 years: 

9 students with an I. Q. of 70 or below. 
4 students with an I. Q. of 71-80. 
4 students with an 1. Q. of 81 - 90. 

Group showing retardation of 4 years: 

4 students with an I. Q. of 71 - 80. 

A study of reading ability in the case of each pupil was made with the co- 
operation of the Psycholog>^ Department of the Boston Psychopathic Hospital. 

Fifty-five (55) children were found to be below grade in reading. Out of these, 
18 children had an I. Q. of 91 - 108. These represent promising material for 
remedial instruction under the psychological department of the Boston Psy- 
chopathic Hospital. 

Statistics of the Out-Patient Department. 
October 1, 1928 — September 30, 1929. 



Total New Cases 1,135 

Out-Patient Department 1,049 

Syphilis Clinic 86 



New Patients: 


Male. 


Female. 


Total. 


Adults 


. 209 


231 


440 


Adolescents .... 


73 


122 


195 


Children .... 


. 254 


160 


414 




536 


513 


1,049 


Plus: 








Syphilis patients 


42 


44 


86 


Total .... 


. 578 


557 


1,135 



Nationality. 





M. 


F. 


T. 




M. 


F. 


T. 


African 


.12 


23 


35 


Italian 


62 


50 


112 


Albanian . 


3 





3 


Jewish 


65 


43 


108 


American . 


284 


262 


546 


Lethish 


1 





1 


Armenian . 


2 


5 


7 


Lithuanian 


2 


4 


6 


Austrian 





1 


1 


Polish 


10 


8 


18 


Canadian . 


19 


34 


53 


. Portuguese 


2 


3 


5 


Danish 





1 


1 


Rumanian 


1 





1 


English 


14 


8 


22 


Scandinavian 


1 





1 


Finnish 


2 


1 


3 


Scotch 


3 


2 


5 


French 


6 


8 


14 


Spanish 


1 





1 


Greek 


4 


9 


13 


Swedish 


7 


4 


11 


Indian 





1 


1 


Syrian 


1 





1 


Insh 


33 


46 


79 


Turkish 


1 





1 












536 


513 


1,049 



Occupation. 



At home 

Housewife . 

Domestic . 

Mother's helper 

Waitress 

Restaurant work 

Nurse 

Hairdresser 

Baker 

Barber 

Upholsterer 



302 
88 
30 
11 

o 

2 
5 
1 
3 
2 
2 



P.D. 137 



Factory work 

Laundry work 

Milkman 

Sh'oemaker 

Janitor 

Farmer 

Laborer 

Bricklayer . 

Stableman . 

Cari>€nter . 

Painter 

Plumber 

Steamfitter 

Tailor 

Mechanic 

Electrician . 

Teams ter 

Chauffeur . 

Motorman . 

Fireman 

Porter 

Engineer 

Railroad worker . 

Coast guard 

Gas station attendant 

Shipper 

Letter carrier 

Delivery boy 

Paper boy . 

Grocery clerk 

Butcher 

Pedlar 

Salesman 

Saleswoman 

Insurance agent . 

Collector 

Salvation army cadet 

Telegrapher 

Jeweler 

Confectioner 

Printer 

Office work 

Interior decorator 

Florist 

Photographer 

Broker 

Dentist 

Bacteriologist 

Chemist 

Artist 

Musician 

Occupational therapist 
Social worker 
Teacher 
Student 



Total 



16 



P.D. 137 



Referred by 





Male. 


Female. 


Total. 


Psychopathic Hospital 


12 


4 


16 


Other hospitals .... 


80 


91 


171 


Local physicians .... 


82 


46 


128 


Social agencies .... 


177 


254 


431 


Schools 


43 


19 




Courts . , • , ■ 


18 


6 


24 


Church .... 


1 





1 


Relatives and friends 


76 


62 


138 


Own initiative .... 


47 


31 


78 


Total 


536 


513 


1,049 



Problems. 

During the past year, patients have been referred to us for aid in solution of 
the following tj'pes of problems: — 

Complete routine examination, placement, vocational guidance, mental retard 
ation, question of chorea, beha\'iour problem, sex delinquency, neurotic traits, 
speech difficulty, reading difficulty, personality problem, question of psychosis, 
somatic complaints, insomnia, worries, memory defect, dizziness, headaches, 
depression, suicidal tendencies, post-encephalitic condition, question of epilepsy, 
after-care, house patients, irresponsibiUty, masturbation, brain tumor, fears, 
alcoholism, inability to concentrate, lack of ambition, seclusiveness, domestic 
difficulties, night terrors, sleep walking and sleep talking, tremor, confusion 
irritability, court charges. 

Diagnosis. 





Male. 


Female. 


Total. 


Manic-depressive, depressed ..... 


23 


27 


50 


Manic-depressive, manic ..... 


1 


4 


5 


Dementia praecox ....... 


23 


13 


36 


Paranoid condition ...... 


8 


4 


12 


Psychosis due to drugs and other exogenous poisons, 








acetanilid . . 


1 




1 


Alcoholic psychoses ...... 


3 




3 


Psychoses with other brain or Nervous disease 


5 


1 


6 


Post-traumatic psychosis ..... 


1 




1 


Undiagnosed psychoses ...... 


5 


7 


12 


Senile psychoses ....... 




1 


1 


Post-en cephalitic- condition . . . . . 


5 





5 


Hydrocephalus ....... 


2 




2 


Organic nervous disease, borderline intelligence 








t hemiplegias ....... 




1 


1 


Organic diseases of the central ner\'ous system 


3 


2 


5 


Endocrine disorder ...... 


1 


3 


4 


Without psychoses, other brain or nervous diseases, 








type undetermined ...... 


3 


2 


5 


Paget 's disease .... 


1 




1 


Brain tumor ........ 




1 


1 


Cephalalgia f migraine) ...... 




1 


1 


Epilepsy . . 


14 




21 


Psych oneur OSes .... 


45 


36 


SI 


Chorea ...... 




1 


1 


Paralusis agitans ...... 


1 




1 


Neurosyphilis ....... 


7 


2 


9 


Constitutional psychopathic inferiority 


16 


23 


39 


Homosexuality ..... 


1 




1 


Exhibitionism ..... 


1 




1 


Sex infantilism ...... 


1 




1 


Without psychoses, headache .... 


1 




1 



P.D. 137 



17 



^onauCb uisorucr ...... 


38 


39 


77 


XNCuroiic cniivi ...... 


27 


13 


4.0 


OpccCii UClC\..b ...... 


6 


3 


9 


XkCaUiXi^ ucicvt ...... 


5 




5 


iN ormai LUHU ...... 


5 


6 


1 1 

X X 


oupciiur 111 tciii{^cucc ..... 


30 


25 


55 


Average inteiiigein-e ..... 


63 


89 


152 


T^iill rmrmal ini'ollitTPTiPP 

XJXXll liUl LUal 111 bCiii|gcut,c ..... 


57 


65 


122 


Jj(jr Uci llilc 111 tciligcii^C ..... 


32 


34 




Mental deficiency ...... 


73 


78 


151 


Alcoholism ....... 


4 




4 


WlvllULlC pojf ^liWOCO ...... 


1 


6 


7 


Diagnosis deferred ...... 


23 



19 




42 




536 


513 




1,049 


Disposition. 








1 reainienb in tne \^ut'~x atienii i.^epai iixiieut 






Old 


/XUIiil L wCU vv vllC X Ojr CllV^p A l/lllV.. XJ.l^S^lbCfcl 


44 


29 


I o 


OptipfaI TTo^Dital 

VJCIlCl al xxvo^ivai ..*■.. 


4 


2 


Q 


Institution for F. M. Advised .... 


8 


2 


10 


State Hospital Advised 


8 


7 


15 


Tlpnnrt to Sooifll Apencv 


131 


227 


358 


Report to Court ...... 


11 




3 




14 




536 


513 


1,049 


Visits. 














2,505 


Visits of new patients ..... 




. 1,436 




Out-Patient Department .... 


. 1,350 






Syphilis Clinic 


86 







Visits of old patients 1,069 

Clinic days 302 

Average attendandp per day ........ 8 

Visits per Month. 
Visits per Old Visits per 

New patients: Month. Patients Month. 

1 .... 822 1 .... 474 

2 .... 184 2 .... 112 

3 .... 18 3 .... 57 

4 .... 19 4 .... 15 

5 . . . . 4 5 .... 14 

6 . . . . 1 6 ... 10 
10 ... . 1 7 . . . 4 

8 .... 1 

1,049 9 . . 1 

15 . . 1 



689 

Clinical staff meetings have been held twice weekly. The discussion of problems 
presented at these meetings, presided over by the Director, has been of distinct 
value to the patient and of keen interest to the staff as well as to the students 
in psychology and psychiatry. 

Respectfully, 

OSCAR J. RAEDER, M.D. 
Chief of Out' Patient Department. 



18 



P.D. 137 



The staff during the year has been as follows: 

Dr. Oscar J. Raeder, Chief of Out-Patient Department. 
Dr. Mary Palmer, Assistant Physician. 

Dr. M. Ralph Kaufman, Acting Chief of Out-Patient Department, April 1, 1929- 
June 12. 1929. 

Dr. Marguerita Kibble, October 6, 1928 to May 31, 1929. 
Dr. Marianna Taylor, Tuesday mornings. 

Dr. Charles B. Sullivan, Tuesday/, Thursday and Saturday mornings. 

Students: Conrad Wall, January 1929; Wiiiiam G. Barrett, January 1929; 
Franklin C. Hugenberger, June 1, 1929 to July 1, 1929; H. H. Hamilton, 
October 3, 1929 to October 23, 1929; Donald E. Higgins, October 23, 1929 to 
November 25, 1929. 

REPORT OF THE CHIEF MEDICAL OFFICER. 

To the Medical Director of the Boston Psychopathic Hospital 
1 herewith submit the medical report for the year. 

One of the most important points to record is the increased use of the X-ray 
equipment and the marked improvement of that service which has come about 
since the introduction of our new equipment. As will be noticed from the report 
of the X-ray technician 726 patients were given X-ray examination during the 
year. 1,900 patients were admitted but readmissions from visit would cut this 
down at nearly 1,800 patients. This serves to indicate the extent to which use 
has been made of our X-ray equipment. All the X-rays of the skull are now 
stereoscopic as it is felt this is the only satisfactory type of X-ray examination 
for the purpose. In addition, fluoroscopic examination further increases the 
value of the equipment. 

There has been such an increase in the use of X-ray films that our present 
allowance is inadequate. It is hoped that the budget for the X-ray department 
can be increased for the coming year. 

Ward A has been kept open continuously through the year so that Dr. Solomon 
has been able to carry on his therapy work on general paresis uninterrupted. 

Ward B has been open for a part of the time, and special biochemical studies 
of febrile and epileptic states have been carried out. Lack of funds has prevented 
the more continuous use of this ward for research studies. 

Considerable work on the use of carbon dioxide in stuporous cases has been 
done. A study has been made of the use of ovarian preparations in cases of 
involution melancholia. A series of such cases has been carefully studied from 
the standpoint of blood chemistry, basal metabolism, etc. They have then been 
treated with amniotin, an ovarian extract, standardized by the Doisy-Allen 
method. 

To date no marked effect has been noted from the use of this preparation. It 
will be continued, however, until we have a larger series of cases from which to 
draw conclusions. 

During the past year, there has been a marked increase in the number of 
physically sick patients admitted to this hospital. Such patients when once 
admitted are often in no condition to be transferred and the result has been that 
at a number of times our wards have been badly over-crowded. It would seem 
that this hospital is particularly suited for the care and treatment of such patients, 
but with the high admission rate we do not have sufficient beds to retain all such 
cases for prolonged treatment. Of particular interest are cases of brain tumor, 
diabetes, pernicious anemia and heart and kidney disease which are transferred 
from Boston hospitals because of the mental condition developing during the 
course of the disease. These cases form an extremely interesting group, and one 
in which the hospital can be of great service. 

Our medical staff has been completely filled through practically the entire 
year. In addition, we have had volunteer workers so that we have been more 
amply staffed this year than ever before; lack of space, however, presents a very 
definite problem, and complicates the work of the hospital. 



P.D. 137 



19 



During the past year it has been possible to carry on more intensive studies of 
selected cases as a part of a program of research made possible by a grant from 
the Laura Spelman Rockefeller Memorial Foundation. It has been possible 
through this grant to secure the services of two psychiatrists, one statistician, 
four social workers and a clerk to aid in this work. 

This research will be continued throughout the coming year. It is essentially a 
study of Schizophrenia in which the personality and the environmental factors 
are carefully and critically analyzed. 

It is hoped that this study will make a definite contribution to the topic of 
schizophrenia. 



The report of Dr. Dalton, the dentist, fol 
Patients examined 
Patients receiving treatment 
Extractions 

Fillings .... 
Prophylaxis 
Other treatments 

Dental X-rays of 84 patients showed 
Infection present 
Infection doubtful 
Infection absent 
Impacted teeth 
Unerupted teeth 
Fourth molars 



ows: 



1,684 
809 
946 
472 
205 
196 

29 
17 
38 
9 
3 
1 



Dr. Dalton's report illustrates the fact that the physical side of the problems 
presented by our patients is receiving every ix)ssible attention. 

The number of pupil nurses from affiliated hospitals has been increased this 
year which is a very satisfactory step from the medical standpoint. There is no 
doubt that the presence of the student nurses leads to improvement in the 
treatment of our patients. 

The X-ray report for the year is given below: 



Number of Patients Examined in X-ray Department. 





Male. 


Female. 


Tota 


December 1928 


20 


21 


41 


January 1929 


26 


16 


42 


February 1929 


23 


27 


50 


March 1929 .... 


33 


41 


74 


April 1929 .... 


43 


33 


76 


May 1929 .... 


63 


35 


98 


June 1929 .... 


42 


29 


71 


July 1929 .... 


30 


35 


65 


August 1929 .... 


33 


17 


50 


September 1929 


21 


25 


46 


October 1929 




25 


52 


November 1929 


19 


42 


61 




381 


345 


726 



Respectfully submitted, 
KARL M. BOWMAN, Chief Medical Officer. 

PUBLICATIONS. 

Bowman, K. M. "Religious Problems in Clinical Cases. "Religious Education 
September 1929. 

Bowman, K. M. "Parathyroid Therapy in Schizophrenia." Journal of Nervous 

and Mental Diseases, October 1929. 
Raymond, A. F. and Bowman, K. M. "Physical Findings in Schizophrenia." 

American Journal of Psychiatry, March 1929. 



20 



P.D. 137 



Bowman, K. M. and Kasanin, J. "The Sugar Content of the Blood in Emo- 
tional States." Archives of Neurology and Psychiatry, FehrusiTy 
1929, Vol. 21, pp. 342-362. 

Bowman, K. M. "Chapter on Fatigue, Worry and the Blues" — "Keeping 
Mentally Fit," Greenberg, 1929. 

REPORT OF BIOCHEMICAL LABORATORY 

To the Medical Director of the Psychopathic Hospital: 

The routine work of the laboratory, during the past year, has proceeded much 
as in previous years. The organization has remained essentially the same except 
for the continuance of Miss Underhill as a part-time chemist to assist Mrs. Kubik, 
who is on full time. The routine work on the patients has been done largely by 
the four student internes who have, as always, given good and efficient service. 
Much of the investigative work of the hospital has required the co-operation of 
the laboratory, and work has continued on the problems outlined in my last report 
without, as yet, resulting in publication of results. In the coming year the force on 
this work will be augmented by the appointment of Dr. d'Elseaux as a fellow in 
psychiatry. So much for certain tangible aspects of the laboratory work. 

In my dual capacity, as Chief of the Laboratory and Consultant in Internal 
Medicine, I desire to call your attention certain to intangible changes in the hospital 
work. Some of these changes may be directly traced to the organization of the 
laboratory on its present basis, which was devised eight years ago. 

Sporadic attempts have been made to systematize the physical care of patients 
suffering from mental disease, but it is only in the last few years that a consistent, 
steady plan to this end has been developed, and it is this development which I 
wish to emphasize from the point of view from which I have been able to observe it. 

Unquestionably, the time has come when psychiatry and internal medicine can 
no longer be divorced as previously. Much of our bemoaning of the passing of the 
general practitioner has been due to the fact, heretofore dimly perceived, that he 
practiced a rude, instinctive psychiatry. To regain that position occupied by the 
old general practitioner, internal medicine is turning more and more to psychiatry, 
and it is my hope that in the years to come, the so-called internist will be able to 
practice consciously, more accurately and more intelligently the unconscious psy- 
chiatry of the old general practitioner. Similarly, as has been emphasized, psychi- 
atry has left the walls of the "insane asylum " and has branched out as a full-fledged 
specialty, intimately related not only with neurology, but also with internal 
medicine, and more remotely with the surgical specialities as well. As I understand 
the situation the laboratory development in the Psychopathic Hospital has been 
calculated towards the latter end. 

Before the laboratory work was organized on the present basis, the laboratory 
examination of patients was haphazard and only the spinal fluids were examined 
with any degree of systematic attention. In the first years of the laboratory, there 
have been chronicled in previous reports the increasing number of laboratory 
examinations made year by year until finally there has developed a routine approx- 
imating, at least, that of a general hospital in the examination of the patients, 
though modified to suit our special needs. As a result, in the last four or five 
years, each patient admitted to this hospital has had, at least, urine and blood 
examinations and most have had a variety of other tests done. Where it was im- 
possible to examine the urine, we have utilized the newer chemical methods of 
blood analysis to rule out diabetes or advanced nephritis at least. In that way, 
our patients have been more safeguarded than ever before. With this development, 
all of us have become keener in detecting the mental symptoms of non-nervous 
system diseases. On two occasions, in the past year, the laboratory has detected 
fairly early cases of Addisonian anaemia evidently with central nervous system 
changes simulating one of the functional psychoses. In regard to those patients 
acutely ill, of which we have a surprising number, we now have adequate laboratory 
information available to the clinical staff. I need only mention the daily white 
counts on all febrile cases to indicate the type of information. 



P.D. 137 



21 



The mention of the clinical staff brings me to a phase of this discussion in which 
my own interest has been particularly keen. From the beginning, we have struggled 
against the classical psychiatric attitude of lack of interest in the physical con- 
dition of so-called mental patients. It is highly gratifying that in the past year we 
seem to have reached a spirit, throughout the clinical staff, which takes into con- 
sideration not only the patient as a whole, but the detailed functioning of his basal 
mechanisms. Particularly is this manifest in the type of requisition which appears 
in the laboratory, and the type of consultations which I am now called to take part 
in. 

At the outset the clinical staff was provided in the laboratory facilities with a 
machine which they did not know how to use to its best advantage. Gradually, 
year by year, the use of the laboratory increased until at one period the laboratory 
was overwhelmed by requisitions, even some for procedures which provided no 
useful information in the given case. Slowly there has permea,ted the hospital 
staff a keen appreciation of precisely the value of each laboratory procedure and 
it is only rarely now that any request for laboratory procedure is to be questioned. 
This is clearly evidenced by the fact that, in my capacity as Consultant in Medicine, 
my work has largely changed from the suggestion of diagnostic laboratory pro- 
cedures to the advising of therapy and weighing of evidence already acquired. In 
brief, cases requiring consultation are now presented thoroughly "worked up". 
This is the end which we have sought and, in the present year, with the present 
staff, this has been so nearly reached that it is gratifying to be able to record it in 
this annual report. 

In the earlier reports of the laboratory, the work of the student internes has 
been praised. Since then, we have taken their work more for granted and, yet we 
perhaps even now do not fully appreciate the conscientous effort that practically 
all the student internes we have had put forward in the accomplishment of the 
results chronicled above. These boys work during their spare hours; they main- 
tain their interest and while, to be sure, they are receiving valuable training 
in the laboratory technique, their work has rarely borne evidence of the drudgery 
involved. The position itself, while carrying no stipend, has become increasingly 
popular amongst the students and we have had students from all three medical 
schools in the City of Boston. 

Not least in this whole development, should credit be given to the chemist, Mrs 
Kubik, and to her assistant. Miss Underhill as full-time workers, who have tied 
together all the relationships in a singularly able and happy fashion. The position 
of chemist is the foundation stone upon which the laboratory must rest, both in 
its research and clinical activities. 

As to the former, during the past year a number of unpublished studies have 
been made; the question of dehydration in epilepsy has been studied to some extent 
from its metabolic aspects; studies of the passage of bromides into the spinal fluid 
have been made; treatment of certain cases with "Amniotin", the newly dis- 
covered ovarian hormone has been followed; further studies on the effects of 
carbon dioxide on patients with stupor have been made, and a few scattered pieces 
of work are in the process of being finished, to be reported in more detail in the 
succeeding report. 

Respectfully submitted, 

G. PHILIP GRABFIELD, 

Chief of Biochemical Laboratory. 

REPORT OF THE PSYCHOLOGICAL LABORATORY 
To the Medcial Director of the Boston Psychopathic Hospital: 

The chief psychometric development during the year has been the introduction 
of the Kuhlmann-Anderson scale as a coordinate with the Kuhlmann-Binet, the 
Stanford, and other "intelligence" tests in regular use. From the point of view 
of internal organization the Kuhlmann-Anderson scale is the best available, though 
scales based on the Binet system retain the advantage of giving a broader, if also 
more subjective picture. The use of the Kuhlmann-Anderson material in single 
sheets, instead of in the booklet form, is recommended for purposes like the present. 



22 



P.D. 137 



The general research project on functional transfer and allied topics, named in 
the last report, was carried out as planned, and the resulting data are now being 
studied. Mrs. Whitman is in immediate charge of this work, as previously. Among 
the leads opened by these experiments, Mrs. Bowie is studying one of the special 
phases of last year's project, a test of "symbolic imagination"'. Besides continuing 
his work in reading difficulties, Mr. Young has charge of a proposed revision of the 
alpha test. Mr. Beck brought to the Laboratory a special interest in the Rorschach 
test, and continues his studies of this important technique. Each of the Laboratory 
staff has one or more student assistants, and ether studies of a psychometric nature 
are undertaken by students under the direct supervision of the writer. 

It may be noted that with the growth of research activity during the past two 
years, the laboratory's publications have diminished. The problem of publication 
is no simple one, and has become of much concern in psychology generally. The 
available channels of publication are badly clogged, although their number has 
increased, and their standards are certainly not becoming less rigid. This is not 
the place to discuss the various psychological bases of the publication urge, but 
there is no doubt that only a very sm.all percentage of the published material is 
effective in the advancement of psychological science, whatever other purposes it 
may serve. The editorial labor of preparing manuscripts can be a very irksom.e 
distraction from proper investigative or clinical interests. On the other hand, 
we have unquestionably a folkway th^t estimates one's scientific status by pub- 
lications considered quantitatively rather than qualitatively. Some thought has 
been given to the problems of publication as related to the Laboratory's own work. 
Material now gathered is probably '"good for"' some twenty average papers, at 
the cost of suspending productive work for some years. This is not because the 
Laboratorv' has given disproportionate time to research, though it does plan to 
give what is necessary to the mental growth of its staff; it is because scientific 
groups generally have established a custom of publishing far more printed pages in 
proportion to a given amount of work than can possibly be assimilated. The 
policy planned here is the publication of rather frequent and quite brief notes of 
research in appropriate psychological publications, as well as of certain special 
material in the Departmental Bulletin; though it may be a year before any of 
this material appears. 

The Laboratory continued its cooperation in Psychological Abstracts, the 
Psychological Index, and the Child Development Abstracts. The writer has con- 
tinued to serve on the Committee on Experimental Psycholog>- of the National 
Research Council, and as a director of the Psychological Corporation and the 
National Institute of Psychology. 

Visits have from time to time been made to the psychological laboratories of 
other institutions in the Department, which it is hoped have been mutually helpful. 
There has been the usual cooperation in the matter of personnel selection. The 
writer presided at a session on ' Maladjustments'' at the International Congress 
of Psychology in New Haven, subsequent to which the Hospital was visited by a 
number of the foreign guests. 

As to changes in the staff, Mr. R. A. Young resigned as psychologist July 1, 1929, 
being succeeded by Miss Wilda Rosebrook. Miss Wilda Rosebrook resigned on 
September 14, 1929, to continue graduate study, Mr. Beck coming as psychologist 
in her place. Mr. Young returned to the Hospital in September, to continue work 
on interne status. Mrs. E. C. Whitman continues as psychometrist, and Mrs. 
Helen Bowie was appointed psychometrist June 10, 1929. 

Publications have been as follows: 
Wells, F. L. "Reaction Time and Allied Measures Under Hypnosis: Report of a 
Case." Journal of Abnormal and Social Psychology, Vol. 23, No. 3, 
October-December, 1928. 
Wells, F. L. "Reaction-Times to Affects Accompanying Smell Stimuli. American 

Journal of Psychology, Vol. 41, No. 1, January, 1929. 
Wells, F. L. "Musical Symbolism." The Journal of Abnormal and Social Psy- 
chology, Vol. 24, No. 1, April-June, 1929. 

F. L. WELLS, Head Psychologist. 



P.D. 137 



23 



REPORT OF NEUROPATHOLOGICAL LABORATORY 

To the Medical Director of the Boston Psychopathic Hospital: 

The Neuropathological Laboratory during the fiscal year ending November 30, 
1929 has been in charge of the Pathologist of the Department of Mental Diseases 
as in the past. During this period there have been 40 deaths and 13 post mortem 
examinations, a percentage of 33. Four of the cases were autopsied by the Medical 
Examiner. 

There were two cases of brain tumor which came to autopsy. One a glioma 
situated in the pons. One of the members of the clinicial staff intends to do some 
pathological work on this brain. The other was a rather small tumor firmly at- 
tached to the pituitary stalk. It was filled with cholesterin crystals of the usual 
shimmery appearance. Microscopically its origin did not seem clear until in its wall 
several small patches of stratified squamous epithelium were seen. This would 
point to the small groups of epithelial cells sometimes found on the hypophyseal 
stalk, as the origin. Perhaps the most interesting point about this tumor is its 
known duraition of 29 years. 

Four deaths were due to acute infections, one to general paresis, one to miliary 
tuberculosis, and one to pernicious anemia. The Medical Examiner's cases showed 
two deaths due to alcohol, and two to fractures with subsequent acute infections. 

The Hospital is still without the services of an assistant pathologist. This 
curtails somewhat the amount of neuropathological work done for the Hospital. 

The laboratory has been used by members of the clinical staff for teaching pur- 
poses in the courses in brain anatomy which are given to nurses from time to time 

Mr. M. P. Pitock, the interne in Bacteriology, reports the following work done 
for the hospital wards: — Blood cultures, 37; throat cultures, 3; spinal fluid 
cultures, 3; urine cultures, 2; stool cultures, 2; smear and culture, 4; widals, 4; 
throat smears for Vincent's Angina, 9; miscellaneous smears, 7. 

Respectfully submitted, 

MARJORIE FLXSTOW, 
Pathologist, Department of Mental Diseases. 

REPORT OF THE DEPARTMENT OF THERAPEUTIC RESEARCH 
To the Medical Director of the Bosto7i Psychopathic Hospital: 

The following is an outline of the work carried on under the auspices of the 
Department of Therapeutic Research for the hospital year 1928-29. 

Clinical studies of the methods of treatment of general paresis and neurosyphilis 
have been continued from previous years. A study of these therapeutic problems 
has gone on continuously since 1914. During this period, a great deal of work 
has been done with a variety of methods in the treatment of cases of neurosyphilis, 
until at the present time we are in possession of methods that give relatively satis- 
factory results if compared to the situation of only a few years back. Whereas 
seven or eight years ago we were quit3 pleased with a relatively good result obtained 
in I0%o( the paretic cases treated, we are now able to obtain even better results 
in some 30 to 40 of such cases. This, however, is by no means the goal sought, 
and we must continue to work for an improvement over these results. 

During th« past year we have devoted a considerable amount of time to the 
study and development of a febrile method of treatment of general paresis, namely, 
sodoku fever, which, we believe is original with this clinic. This method is now 
being investigated to some extent in several clinics in the United States and Europe. 

Statistics are being collected in order to determine, as far as may be possible, the 
relative value of the several methods now employed in the treatment of general 
paresis. The material coming out of our experience in the treatment of neurosyphilis 
for the past fifteen years is so extensive that it would seem to merit a report in 
monographic form. 

Funds have been granted to us by the Committee for Research in Syphilis to 
attempt a study of the effect of early anti-luetic treatment, as usully given in the 
better grade clinics, on the later course of neurosyphilis, and especially as to its 



24 



P.D. 137 



value in the prevention of general paresis. This study has been well advanced 
during the current year. 

It may be pointed out that once an organization has been evolved that allows 
for investigative procedures, new problems constantly arise out of those already 
being studied which could be carried on without undue new expenditure. And 
again, small additional expenditures will allow for considerable expansion. As 
already noted, we were fortunate enough to receive a small grant from the Com- 
mittee for Research in Syphilis. We were also the recipient of funds from the De- 
Lamar Mobile Research Fund of the Harvard Medical School. With the aid of 
this latter grant, a piece of work on salt and water metabolism in experimentally 
produced fevers was carried to completion. Dr. Frank Fremont-Smith of the 
Department of Neuropathology of the Harvard Medical School collaborated in 
this Research. 

Collaboration and assistance in the development of the Hinton Test was afforded 
by Dr. A. Berk of this Department. This is a new serological test for syphilis 
developed by Dr. W. A. Hinton. The importance of this test, from our particular 
point of view, is that it is apparently capable of giving a positive reaction in almost 
all cases of neurosyphilis. If the evidence thus far obtained is corroborated, it will 
be a most valuable means of reducing the use of lumbar puncture. 

During the spring, preliminary studies concerning the effect of dehydration on 
convulsive attacks was undertaken. This work consisted of two parts: (1) ob- 
servation of the clinical results in this type of treatment, and (2) the effect of 
dehydration on the metabolism of the patients. This work necessitated a rather 
elaborate set-up. A small ward of the hospital was made available. A special 
dietitian and two attendants were required. Dr. G. P. Grabfield, in charge of 
the laboratory at the hospital, collaborated, and Mrs. Emily Kubik, the hospital 
chemist, devoted a great deal of her time to this preliminary study. Interesting 
observations on the reduction of the number of convulsions under this treatment 
were made, and some very interesting leads concerning the nitrogen, sulphur, and 
phorphorus metabolism were obtained. We believe that this work should be 
continued, but until new funds are ootained, this is impractical. The money 
required, outside of the hospital budget, for carrying out this work this past 
spring, was obtained from the Department of Psychiatry of the Harvard Medical 
School. 

During the period under consideration, studies were made on the effect of the 
inhalations of high concentrations of carbon dioxide in certain neuro-psychiatric 
conditions. Dr. R. M. Kaufman, a Fellow under the Commonwealth Fund, 
devoted a considerable portion of his time to this work. Part of the expenses 
incident to this study were defrayed by the Department of Psychiatry of the 
Harvard Medical School, and part by a grant from the Joseph M. Herman Research 
Fund. In certain stuporous conditions, the inhalation of carbon dioxide in con- 
centrations of 20 to 40% over a period of two or three minutes caused the patient 
to come out of the stupor into a state of more or less normal lucidity for a period 
of one-quarter to one-half hour. This work would seem to give a most important 
lead in understanding certain phases of psychiatry. This problem is to be studied 
with considerable elaboration during the coming year. 

HARRY C. SOLOMON, 
Chief of Therapeutic Research. 



STATISTICS OF SYPHILIS SERVICE (Abbreviated Report) 
October, 1928 — September, 1929 

House patients: 

New 147 Ref. from O.P.D 7 Old 65 Total 219 

Out-patients: 

New 26 House 25 Old 154 Total 206 

New 109 Old 15 Total 124 



p. D. 137 



25 



Visits made by 273 persons... ... 3,336 

Number of new and old cases continued for treatment or examination . 48 1 

Treatments (O.P.D. and House) = . 2,982 

Arsphenamine . . . 247 Sodoku .... 18 

Bismuth .... 295 Tabetic training . . 12 

Drainage .... 4 Tryparsamide . . . 1,897 

Malaria .... 15 Typhoid Vaccine . . 126 

Mercury .... 40 Ventriculographies . 10 
Neoarsphenamine . . 318 

Diagnostic lumbar punctures 905 

Percentage of families followed who vrere examined 78.89 

Percentage of relatives folloT.ed who veve examined 63.91 

Percentage of families examined showing evidence of syphilis . . .23.15 

Percentage of relatives examined showing evidence of syphilis . . . 21.77 



Publications from the Department 

Solomon, H. C. and Berk, A.: " Prolonged Treatment in Neurosyphilis" American 
Journal of Syphilis, November 1928. 

Berk, Arthur and Tivnan, Paul: '"Apparatus for Pneumorachiocentesis. Ar- 
chives of Neurology ciid Psychiatry, September 1929, Vol. 22, pp. 582-5S4. 

Hinton, William A. and Berk, Arthur: '"A Glycerol Modification of the Kahn 
Test." N. E. Journal of Medicine, Vol. 201, No. 14, pp. 667-670, October 2, 1929. 

REPORT OF THE CHIEF EXECUTIVE OFFICER 
To the Medical Director of the Boston Psychopathic Hospital: 

There have been few changes in the executive routine during the past year. 
Indeed it would be hardly possible to effect any major changes, if such were de- 
sirable, inasmuch as a large part of the executive work consists in compl>-ing with 
the various laws and Departmental regulations relative to the reception and dis- 
missal of patients. The daily amount of work in this respect varies widely, but 
in looking over records for the year it is found that the executive officers supervised 
the reception and dismissal of one thousand nine hundred patients, held approxi- 
mately nine thousand interviews with relatives of patients, and received and sent 
out approximately fifteen thousand telephone calls relative to the condition and 
disposition of patients. During the year there were eighteen thousand two hundred 
and nineteen visits to patients by relatives and friends. 

Another major function of the executive department has been the expenditure 
of appro.ximately two hundred and fifty thousand dollars, divided into the following 
percentages: 



Personal services 63.7 

Food 14.5 

Medical and general care 7.3 

Heat, light and power 4.6 

Repairs and renewals 2.8 

Travels, transportation and office expenses 2.4 

Furnishings and household supplies 2.0 

ilepairs ordinary 1.57 

Clothing and materials .51 

Religious instruction .47 

Grounds .15 



Under each of these items the appropriation has been ample to maintain usual 
standards. 

It will be seen that the payments for personal services comprise nearly two- 
thirds of the entire appropriation. This is due to the fact that this hospital main- 
tains a personnel of 160 employees with a daily average patient population of 
approximately eighty. This proportion of employees to patients at first thought 
seems rather startling; however, when it is considered that there have been 1,900 
admissions and readmissions into the hospital during the year, with 2,505 exam- 



26 



P.D. 137 



inations in the Out-Patient Department, 2,892 treatments given in the Neuro- 
Syphiiitic Clinic, and 1,403 investigations by the Social Service Department, 
together with approximately 4,000 abstracts of case records sent to other hospitals 
and various social agencies, it will be seen that a large personnel is necessary. 
In addition to the above specific enumerations, there are also the matters of teaching 
and special research, both of which require a very considerable amount of time and 
a specially skilled personnel. Another factor contributing to the proportionately 
large pay roll is the inadequate housing facilities for employees. At the present 
time there are 21 employees who receive in the aggregate the annual amount of 
$6,300 in lieu of quarters and maintenance. 

There have been few changes in the permanent personnel during the year. 
Sixty-five have resigned and 18 have been discharged as incompetent for the 
particular type of work required. (These figures apply to temporary as well as 
permanent personnel.) About 97 percent, of the full quota has been maintained 
throughout the year. The morale has been excellent, and no serious difficulties 
have arisen from lack of cooperation. It is, of course, inconceivable that in a 
progressive organization there will not be difference of opinion, which in some 
instances lead to slight temporary friction, but be it said to the credit of every 
officer at the Boston Psychopathic Hospital, the spirit of cooperation has always 
prevailed. 

The upkeep of the physical plant has been maintained in a fairly satisfactory 
manner. Much in the way of repainting has been done, particularly since the 
addition last June of a full time painter to the pay roll, new Rubberstone floors 
have been laid in six rooms, and fifteen badly corroded iron cold water risers have 
been replaced by brass piping. The building is now reaching the age where num- 
erous repairs and replacements will soon become necessary, and the employment 
of two carpenters instead of one will be required to keep the building up to desired 
standards of repair. 

The new X-ray equipment has been in operation for about ten months, and has 
proved entirely satisfactory and a big improvement over the old equipment. Con- 
siderable new equipment has been added to the kitchen and dining room service, 
and many minor betterments have been added here and there. 

While responsibility for the treatment and general comfort of the patient popu- 
lation rests largely with the Medical Staff under the immediate direction of the 
Chief Medical Officer, important executive functions are to provide food, clothing, 
housing, and ward personnel. No pains or expense have been spared in these 
important matters. 

My thanks to the State Department of Mental Diseases for guidance and support, 
to the Board of Trustees and Medical Director for advice and co-operation, and to 
each employee for faithful service are due and hereby acknowledged. 

Respectfully submitted, 

ARTHUR N. BALL, M. D. 

Chief Executive Officer. 

REPORT OF SOCIAL SERVICE DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

During the last year with the exception of a period of a few months there has 
been a full staff. Miss Dorothy Stebbins, who was appointed on December 1, 
1928, left on March 15, 1929 to become chief worker at the Habit Clinics, an organ- 
ization iti which she had trained as a student. In June, her position was filled by 
Mrs. Anne G. Beck, a Master of Arts student from Columbia University and a 
special student of the New York School of Social Work. 

In May of 1929, Miss Dorothy Whittaker left after one year and nine months 
service in the Syphilis Department. Her position was filled on August 5, 1929, 
by Miss Charlotte Nicklin, a graduate of Mt. Holyoke College. 

In addition to the regular staff there have been four students working part time 
under the Simmons School of Social Work and part time under the Laura Spelman 
Rockefeller Memorial fund on cases of schizophrenia, manic-depressive psychoses 
and general paresis. They have obtained supplementary information on person- 



P.D. 137 



27 



ality traits and environmental conditions, which material has been added to the 
information collected by the physician from relatives and patients to make a more 
complete life picture of the patient. Six months after the date of discharge, patients 
so studied have been visited in order to ascertain the degree of their present ad- 
justment and to obtain further information if such has been found lacking during a 
review of the case. Several patients already visited have been found to be getting 
along so well in the community that the original diagnosis has been challenged. 

Throughout the year eleven students from the Simmons School of Social Work 
have spent several days a week, three months at a time, working in the depart- 
ment, handling a few new cases and reviewing cases studied by other workers. 

The increased staff has enabled the department to double practically the number 
of cases carried during previous years. There are still many patients, however, 
such as those who leave the hospital against advice and "on visit" who need 
supervision but cannot be followed by the department unless there is an enlarged 
staff. 

The question is raised frequently as to whether a hospital in which the majority 
of patients stay less than ten days and where only about fifty patients a year are 
discharged under the legal supervision of the hospital for a trial visit of a year can 
give opportunities for workers to have under social supervision cases which have 
been studied for at least several months. A review of the patients under the care 
of the department shows that a large number of the cases under intensive super- 
vision have resided in the hospital for from three to ten months. Many of these 
have reported to the Out-Patient Department during the several years they have 
been outside of the hospital. Another group who were in the hospital for only a 
week or so have been followed by the Social Service Department for periods vary- 
ing from one year to ten years. 

H. S., a married woman of fifty, a case of manic-depressive psychoses with 
alternating manic and depressive attacks, had two admissions of ten 
days duration in 1918. Later, she was sent to the Boston State Hospital 
where she remained for several months, being then discharged to the Out- 
Patient Department of this hospital, the former hospital having no such 
department. Recently, she was readmitted to the Boston State Hospital 
upon the advice of the Out-Patient Department. 

During the periods when she has not been sick enough to be in a hospital 
she has been a great annoyance to her family because she is a poor house- 
keeper, very extravagant in her buying, spending all day frequently at 
church, being over-solicitous of her grown daughters, not wishing them to 
be out of the house in the evening. The social worker has served as an 
interpreter of the patient to her family, of the family to the patient, has 
aranged vacations for the patient which have proved to be of great value 
to the family also. 

During this last year more cases have been carried on a co-operative basis than 
previously. Sometimes both the Social Service Department and the outside agency 
have been visiting the family at the same time. On other cases the outside agency 
has remained inactive while the Social Service Department has been active and 
again the opposite arrangement has been carried out. Such a contact is of benefit 
to both agency and hospital, each having an opportunity to evaluate the contri- 
butions which the other gives to the case. Twenty-five different agencies, covering 
all forms of case work, medical, family, children's, relief, preventive, have had 
cases supervised in this way. 

As usual, the investigation of the cases sent to the hospital from the courts has 
occupied a large part of the time. About 150 cases from fifteen different courts 
arrested for all types of offences such as intoxication, forgery, assault and non- 
support were investigated. Some of the cases had already been found guilty and 
were sent to the hospital for examination to ascertain whether they should be 
declared responsible for the misdemeanor committed. Others were sent to find 
out whether they were capable of standing trial. 

About thirty percent were found to be in need of immediate care in mental 
hospitals. Investigation revealed often that some of these individuals were very 
dangerous. 



28 P.D. 137 

H. B., an unmarried man of 34, was sent to the hospital following arrest 
after an unprovoked assault with a razor on a high school boy who was " 
walking along the street. During his hospital residence he was evasive and 
asked frequently why the examination was being made, would give no ex- 
planation of his behavior. There were no hallucinations. Outside investi- 
gation indicated that patient lived alone, had no friends, used an assumed 
name, thought that people stole things from his room. Letters and 
writings found in his room showed that he felt that he belonged to royalty. 
A diagnosis of schizophrenia was made and recommendation sent to court 
that the patient was insane and committable with a chronic type of mental 
disorder. Patient was returned to jail where he remained two months for 
a hearing before the Grand Jury. At that time he was adjuged guilty 
but insane and committed to a State Hospital. 
Other patients while found to have been suffering from mild mental disorder 
were thought to be sufficiently normal to stand trial. In such cases, however 
when the history revealed that the patient was greatly upset at the time of com 
mitting the crime a lenient sentence was imposed. 

G. M., an unmarried man of 36, was sent to the hospital because he had 
forged checks and was found carrying a revolver. Investigation revealed 
that he had no previous court record but had been extremely depressed on 
various occasions. Shortly before arrest he had planned to commit suicide 
and had decided to have one "last fling." He had no money, so he forged 
his cousin's name to some checks. During hospital residence he improved 
greatly and was returned to the court as normal where sentence was 
changed from several months in the House of Correction to probation. 
Many other illustrations could be given proving the value of psychiatric examina- 
tion and social investigation as a means of determining proper disposal of those 
who have offended against the law. 

Contributions have again been received from the Junior Red Cross, The Junior 
League and The South Friendly Society of the First Unitarian Church and other 
interested individuals. 

Respectfully submitted, 

ESTHER C. COOK, 

Head Social Worker. 



SOCIAL SERVICE STATISTICS 
December 1, 1928 to November 30, 1929. 



Total Cases for Year 
New Cases . 



Intensive 
Minors Adults 



1,403 
1,172 

Slight Service 
Minors Adults 



House (30 % of admissions) 


100 


249 


36 


85 


Out-Patient (25% of admissions; . 


174 


54 


125 


94 


Research 


2 


128 




71 


School Survey 


114 








Continued Cases, 231: — 










House 


22 


33 




25 


Out-Patient 


36 


28 


21 


6 


Research 




35 




25 



3. House Cases: 

Investigation: — Court cases, 159; Outside history because no informant 
came to hospital, 102; Contradictory evidence, 56; Additional social informa- 
tion, i.e., court records, employment, etc., 267. 

After-care visiting: — Doing well, 89; Not improved, 68; Readmitted to 
hospital, 23; Institutional care, 7; Died, 3. 

Case work: — including financial assistance, adjustment in industry, place- 
ment in home, etc., 202. 



P.D. 137 



29 



4. Out-Patient Cases: — 

Investigation of court cases, 29; History, 45; Slight service including reference 
to agencies, consulting with agencies, personal service, 185; Case work, 117. 



5. Outstanding Social Problems: 

Diseases: — 

Jllental 329 

Physical 71 

Personality problems, including temperament, vacillating interests, 

instability Z54 

Sex problems 79 

Legal problems, including larceny, assault, forgery, etc 118 

Environmental: 

Financial difficulties 116 

Employment 112 

Marital difficulties 129 

Unsuitable surroundings, broken home, friction in the home, inade- 
quate physical surroundings, immoral parents 178 

6. Expense $479.78 



SOCIAL SERVICE STAFF. 
Head Social Worker, Esther C. Cook, July 1, 1928. Assistants in Social Service: 
Villa T. West, June 11, 1928; Ethel A. Gleason, June 11, 1928: Ethel Goodwin, 
July 8, 1928; Dorothy Stebbins, December 1, 1928, resigned, March 15, 1929; 
Anne G. Beck, June 25, 1929. Syphilis Follow-up workers: — Dorothy Whittaker, 
September 26, 1927, resigned, June 1, 1929; Charlotte Micklin, August, 5, 1929. 

REPORT OF THE PRINCIPAL OF THE SCHOOL OF NURSING 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith present the annual report of the Nursing Department for the year 
ending November 30, 1929. 

On Nursing Service: Principal of the school of nursing, 1; assistant principal of 
the school of nursing, 1; nurse instructor (full time), 1; female supervisor (night), 
1; male supervisor (day), 1; assistant supervisors, 2; head nurse, operating room' 
1; head nurses, wards, 6; assistant head nurses, 2; student nurses, 14; hydrothera- 
pists, 2; female attendants, 8; male attendants, 14. 

Head Nurses resigned: Mrs. Violet Churchill, Miss Caroline Slade, Miss Margaret 
Davis, and Miss Elva Russell. 

Head Nurses appointed: Miss Mary Johnson, Mrs. Mary Byrne, Miss Margaret 
McKay and Miss Dorothy Allen. Miss McKay a graduate of the Cambridge 
Hospital and Miss Allen a graduate of the New England Baptist Hospital, both 
took the affiliated course here. 

During the year 50 affiliated student nurses completed the course in psychiatric 
nursing. 

Special Nursing: Number of special nurses, 33. Total number of weeks in wards, 
45. 

Hydrotherapy: Tonic baths, number of patients, 247; foot baths, 948; salt 
glows, 761; saline baths, 181; sitz baths, 97; electric light baths, 508; hot and 
cold applications to spine, 34; wet sheet packs (as preparatory treatment), 13; 
tub shampoos, 586; head shampoos, 450; needle sprays, 3,180; fan douches, 3,180; 
jet douches, 814; rain douches, 450; scotch douches, 79; continuous baths. 
Number of patients, 449. Number of baths, 2,410. Number of hours, 17,711. 

Wet sheet packs, number of patients, 50; number of packs, 146. Number of 
hours, 436. 

Instruction in wet sheet packs and tonic baths was given to 74 nurses. Number 
of lessons, 459. Number of hours, 474. 

In May of this year we started an affiliation with the Winchester Hospital, 
Winchester, Mass. This hospital has a,greed to send us two student nurses every 
three months. 



30 



P.D. 13' 



In October the Beth Israel Hospital discontinued affiliation on account o 
the shortage of nurses, due to the opening of their new hospital. They are takini 
in larger classes of students and hope to be able to renew affiliation in 1931. 

The Winchester Hospital is sending us four student nurses the first of Februar; 
instead of two. and may continue to do so throughout the year. This will supply 
the shortage caused by the temporary withdrawal of the Beth Irsael students. 

October first we accepted Miss Judkins a nurse from the Ellis Hospital, Schenec 
tady, New York, for a three months course in psychiatric nursing. She receivei 
no remuneration as her own hospital provides a special fund for this course, whicl 
is elective. 

This department shows a steady growth and every effort is being made to in 
crease its efficiency. With better nursing facilities, many of our difficult nursinj 
problems have been met more satisfactorily, especially in caring for our overactive 
physically ill patients who require constant vigilance and careful nursing. 

The Head of the nursing service take this opportunity to express her appreciatior 
for the encouraging and kindly support of the Medical Director and Chief Executive 
Officer, to the Medical Staff for the splendid spirit shown in giving so much of theii 
time in lecturing to the student nurses, also for the cooperation which has beer 
shown by the other departments of the hospital. 

Respectfully submitted, 

MARY FITZGERALD, 
Principal of the School of Nursing 

REPORT OF THE DEPARTMENT OF OCCUPATIONAL THERAPY 

To the Director of the Boston Psychopathic Hospital: 

The Occupational Therapy Department has carried on its usual activities and 
closes the year with the hope that it is in a good position for further advance. Wc 
have been especially interested in the group of patients who remain in the hospital 
for periods of more than ten days. We feel that especial provision should be made 
for this group during their hospital residence. We are hoping to be able to co- 
operate more closely with the physicians in charge and to make an effort to arrange 
a more consistent program for this group. For the transient patient the principal 
things attempted are the establishment of confidence in the hospital regime and 
the continuance of normal interests and activities. 

We have been fortunate since July in ha\'ing with us students from the Boston 
School of Occupational Therapy. These students have received part of their 
training in Occupational Therapy with mental patients in this department. We 
are always glad to receive students as they bring fresh interests, they also make 
it possible to carry on to better advantage the occupational work on Ward 3 and 
to give special attention to certain patients who are in particular need of work of 
this type. The hospital training course serves these students as a bridge across the 
gap that separates the theory of the school from actual hospital practice. It also 
helps them to correlate their special interests with the other departments of the 
hospital. We have also continued to give a two weeks period of training to the 
affiliated nurses. Their time is short but we endeavor to give them some insight 
into our aims and methods as well as a little practice in the crafts. 

For most of the year we have carried on work on Saturday mornings with the 
children in the Out-Patient Department. This contact has been interesting and 
has seem.ed worthwhile. We should be glad to develop this work as well as the 
ward work still further if we were not so limited in personnel. 

The recreational program has been arranged this year with dances in the As- 
sembly Hall and informal parties in the Sun Room of the Department. We have 
made use of moving pictures for entertainm.ent with good success. We should be 
glad to arrange for these parties more frequently and we hope that sometime the 
hospital may reduce their expense by the purchase of a moving picture machine. 

We have continued our interest in the furnishings of the wards and the Sun Room 
is at present being rendered more attractive. We have again made use of the 
project of printing a calendar as we find that this forms an unusually good group 
problem. 



P.D. 137 



31 



An exhibit of the work of the department was sent to the Annual Convention 
of the Massachusetts Occupational Therapy Association. 
The star^stics of the department are as follows: — 
Articles made, 1,280; forms printed, etc., 22,700. 
Average daily attendance — women, 20: men, 16. 
Total yearly attendance — women, 55o; men, 5S5. 

Respectfully submitted, 

ETHELWYX F. HTMPHREY. 

Chief Occupational Therapi^. 

PUBLICATIONS FROM THE CLINICAL SERVICE AND LABORATORIES 
Berk, Arthur and Tivnan, Paul — '"Apparatus for Pneumorachiocentesis." 

Archives of Neurology and Psychiatry, September 1929, Volume 22. pp. 5S2-5S4. 
Bowman, K. M. — "Religious Problems in Clinical Cases." ReUgwits Edueatiamy 

September 1929. 

Bowman, K. M. — ''Parathsroid Therapy in Schizophrenia." Jomrmal ^ Ntmms 

and Mental Diseases, October 1929. 
Bowman, K. M. and Raymond, A. F. — ' Physical Findings in Schizophrenia-'* 

American Journal of Psychiatry, March 1929. 
Bowman, K. M. and Kasanin, J. — " The Sugar Content of the Blood in Emotional 

Stc.tes. Archives of Neurology and Psychiatry, February 1929, Volume 21, 

pp. 342-362. 

Bowman, K. M. — "Chapter on Fatigue, Worry and the Blues — Keeping Mentally 
Fit, Greenberg, 1929. 

Campbell, CM. — ' Personal Factors in Relation to the Health of the Individual 

Worker." Mental Hygiene, Volume XIII. No. 3, July 1929. pp. 4S3-495. 
Campbell, C. M. — '"Hysteria as a Practical Problem." Bulletin of the Xe-ac Yerk 

Academy of Medicine, second series, 1929, Volume V. pp. 1057-1072. 
Campbell, C. M. — ''The Schizophrenic Maladjustment." Xinth IntenuKtitmal 

Congress of Psychology, Yale University, New Haven, September 1929. 
Hinton. William A. and Berk, Arthur — ' A Glycerol Modification of the Kahn 

Test." X. E. Journal of Medicine, Volume 201, No. 14, pp. 667-670, October 

2, 1929. 

Kasanin, Jacob and Kaufman, M. Ralph — ' A Study of the Functional Psychoees 
in Childhood-" American Journal of Psychiatry, Volume IX, No. 2, September 
1929, pp. 307-384. 

Kaufman, M. Ralph — ' Psyhosis in Paget's Disease." Archives of Xeitroiogy cmd 

Psychiatry, Volume 21, April 1929. pp. S2S-837. 
Solomon, H. C. and Berk, A. — ' Prolonged Treatment in Neurosyphilis." Amfri- 

can Journal of Syphilis, November 1928. 
Wells, F. L. — '• Reaction Time and Allied Measures L'nder Hypnosis: Report 

of a Case." Journal of Abnorrnal and Social Psjfckolon, Volume 23, No. 3, 

October-December 1928. 
Wells, F. L. — '* Reaction — Times to Affects Accompanying Smell StimulL'* 

American Journal of Psychology, Volume 41, No. 1, January 1929. 
Wells, F. L. — Musical Symbolism." The Journal af Abnormal and Social Ps^if 

chology, Volume 24, No. 1, April-June 1929. 



32 



P.D. 137 



VALUATION 

November 30. 1929 
Real Estate 

Land. 2 acres $45,060 00 

Boildiiiss 568.852.23 

$613,912.23 

Pkrsoxal Property 

Travel. transportation and office expenses $3,774.49 

Food 3.087.65 

Clothing and materials 1.253 .61 

Furnishings and household supplies 21.526.50 

Medical and general care 18.763 . 69 

Heat, light and power 612 . 25 

Farm - 

Garage, stables and grounds 126. 15 

Repairs 1.227.92 

$50,372.26 

SOXMARY 

Realestate $613,912.23 

Personal property , 50,372 .26 

$664,284.49, 

FIXANXIAL REPORT ^ 
To the Department of Mental Diseases: 

I respectfully submit the following report of the finances of this institution for 
the fiscal year ending November 30, 1929. 

Cash Accol-n-t 
Receipt 

Income 

Board of Patiekts $6,746.32 

Reimbursements 1.472.29 

$8,218.61 

Personal Services: 

Reimbursement from Board of Retirement 92 64 

Sales: 

Food $142.29 

Medical and general care 80.40 

Repairs. Ordinary' . . ' 56 .29 

Arts and crafts sales 53 .29 

Total sales $332 2 " 

AIisch-laxeocs : 

Interest on bank balances $254 85 

Rent 1.800 00 

Sundries 152.00 

2,206.85 

Total income . $10,850.37 

Maintenance 

Balance from previous year, brought forward $3.128. 15 

Appropriations, current year 254. 700. 00 

Total $257,828.15 

Expenses (as analysed below) 242,165.84 

Balance reverting to Treasiuy of Commonwealth $15,662 .31 

Analjfgis of Expenses 

Personal Services $155,589.15 

Religious Instructions 1,040.00 

Travel, Til\nsportation as9) Other Expenses 5,603.99 

Food 35,698.04 

Clothing ant) Materials 871.22 

FU-RNISHINGS AND HOUSEHOLD SLT»PLIES 4.927.98 

Medical ant) Gerneral Care 18.311.93 

Heat. Light and Power 10,753.11 

Garage, Stable and Grounds 383.79 

Repairs Ordinary 3.526.28 

Repairs and Ren-ewals. 5.460.29 

Total expenses for Maintenance $242,165 .84 

Special Appropriations 

Balance December 1. 1929 $5,601.79 

Expended during the year fsee statement below) $5,432 . 54 

Reverting to Treasury of Commonwealth 5,432 .54 

Balance November 30. 1929. carried to next year $169,25 



P.D. 137 



33 









Expended 


Total 


Balance 




Act or 


Whole 


during 


Expended 


at End 


Object 


Resolve 


Amount 


Fiscal Year 


to Date 


of Year 


X-ray equipment 


Ch. 127. Sec. 5. 


$5,800 00 


$5,432. 54 


$5,630 75 


$169.25 




Acts 1928 











Per Capita 

During the year the average number of inmates has been 79.27 
Total cost for maintenance, $242,165.84 

Equal to a weekly per capita cost of $58.75 (52 weeks to year) 

Receipt from sales, $332.27 

Equal to a weekly per capita of $.0806 

AH other institution receipts, $10,518.10 

Equal to a weekly per capita of $2.5516 

Net weekly per capita $56.12 

Respectfully submitted, 

ELIZABETH LIBBER, 

Treas^urer. 

STATISTICAL TABLES 
As Adopted by the American Psychiatric Association 
Prescribed by the Massachusetts Department of Mental Diseases. 

Table 1. General Information 

Data correct at end of hospital year. November 30, 1929 

1. Date of o-ptning as a hospital for mental diseases, June 24. 1912. 

2. Type of hospital: State- 

3. Hospital plant: 

\'alue of hospital property: 

Real estate, including buildings $613,912.23 

Personal property . . . 50,372.26 



Total $664,284.49 

Total acreage of hospital property owned, 2.04 acres 
OflBcers and Employees (November 30, 1929) 

Actually in Service Vacancies at End 

at End of Year of Year 

M. F. T. M. F. T. 

Superintendents 2 - 2 - -- 

Assistant physicians 14 1 15 - 1 1 

Medical internes 1 1 2 - - 



Total physicians 17 2 19 

Resident dentist 1 - i 

Pharmacists 1 - i 

Graduate nurses 2 12 14 

Other nurses and attendants ... 18 16 34 

Occupational therapists - 2 2 

Social workers - 6 6 

All other oflBcers and employees ... 22 47 69 



Total officers and employees . ... 61 85 146 - 3 3 

!4oTE: — The following items. 5-10, inclusive, are for the year ended September 30. 1929. 
5. Census of Patient Population at end of year: 

Absent from Hospital 
ActuaUy in Hospital but Still on Books 

M. F. T. M. F. T. 

White: 

Insane 34 30 64 15 22 37 



Mental defective; 


1 


J ■) 








.\11 other cases 


r. 










Total 


41 


32 73 


15 


22 


37 


Other Races: 












Insane 


3 


1 4 


1 




1 


Total 


3 


1 4 


1 




1 


Grand Total. 


. 44 


33 


16 


22 


3S 



34 

Males 

6. Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 19 

7. Other patients employed in genersil work of hospital on date of report 1 

8. Average daily number of all patients actually in hospital during year 41 . 60 

9. \'oluntar>' patients admitted during year 35 

10. Persons given advice or treatment in out-patient clinics during year 1,214 

Note: — The following tables, 3-18, inclusive, are for the Statistical year ended September 30. 1929. 

Table 2. Financial Satatement. 
See treasurer's report for data requested under this table 




P.D. 



137 



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Tl« CO 


eg CO T-t 1 


CO CO 


1-H «0 


t> 




?0 r-i 


t- eg 


eg 




1-H 00 


eg 1-H 


CO 



















o 



a 

S 

*» 
a 

0) 

c 
o 



c .2 M 

.2 c 
*» £ fc, 

Ph < 



" J3 b 
2 53 S 3 

>» ^„ CO 

1:? •= *C O 

E-o-^ E 
* 5 — 

oS 6S ej 

H -S .2 < 
H H Q 



o 

. S5 
>» — 

-Si 

-So 

t3 O 
C O 
e9 ^ 

a 

0) o 



as 



o O e4 
73 >. - 0) 

5* J? ° >» 

0) O ^ 73 ^ 

2 C ^ t ^ 

EC • - CO 

<U 

00 09 00 U • — 



„ o 



^ c a> 



a; a 

* «« 2 



c ^ 

►So 



0) 

a 



Table 4. NaHriiy of Firsf Admissions and of Parents of First Admissions. 



Nattvitt 


i— 






pAiLENTS OF 

Patisnts 


Male 


P.\RBNTS OF FE3f.VLS 

Patients 


M. 


p_ 








Bo:- 

Pijrer.:? 




Both 

-s Mothers Parents 


United States 
















19 


14 


Africa 


_ 


1 


; 


- 


- 


- 


- 


— 


— 


Canada^ 


5 


6 


11 


7 


10 


5 


9 


9 


7 


Denmark 


1 


— 


1 


1 


1 


1 


— 


- 


- 


England 


2 


- 


2 


4 


2 


2 


4 


3 


3 


Fiance 


_ 
_ 


- 
- 


— 
- 


- 
1 


- 
1 


— 
1 


1 

- 


- 




Gcnnany 


1 


_ 


1 






1 






_ 


Ireland 


4 


5 


9 


12 


14 


12 


12 


15 


10 


Italy 


3 




3 


4 


4 










Poland 


2 


- 


2 


2 


3 


2 
















2 














3 


3 


6 


5 


4 


] 


6 


5 


5 


SoMland 


2 


4 


6 


3 






4 


4 


4 


South America .... 




1 


1 








1 


1 


1 


Sivcden 


•> 


2 


4 


3 


2 




2 


2 


2 


Wales 








1 












Unaaccftained .... 






- 


1 


2 




2 


1 


1 




63 


59 


122 


63 


63 


48 


59 


59 


47 



1 Tnctadga Newfoundland 



P.D 137 



37 



a > 



I I I I 

I - r r 



III 



I — I I I » I t 

I I I I I — I I I 

— <C tNi-j-r - - 



- , I 



Si 



S = 

c3 « 



— I I I I I I I 

- I I I f r r r 



u", -s I" I — -f I 



ts r>j cs — — 



fN. c -r : — 



ao 



ac 1^ p^ ^ tN till 



: i/^ I I — — 



C "N O 



5 °^ . 



38 

Table 5. Citizenship of First Admissions. 

Males 

Citizens by birth 38 

Citizens by naturalization 12 

Aliens 11 

Citizenship unascertained 2 

Total 63 



Females Total 



59 



Table 6. Psychoses of First Admissions. 



75 
24 
21 
2 

122 





M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic psychoses 








- 


1 


1 


2. Senile psychoses 








— 


1 


1 


3. Psychoses with cerebraJ arteriosclerosis 








1 


1 


2 


4. General paralysis 








31 


_ 


31 


5. Psychoses with cerebral syphilis 








1 


_ 




6. Psychoses with Huntington's chorea 








- 


_ 


- 


7. Psychoses with brain tumor 








1 


— 


1 


8. Psychoses with other brain or nervous diseases, total .... 








2 


2 


4 


Other diseases 








— 


— 


— 


9. Alcoholic psychoses, total 








- 


- 


- 


10. Psychoses due to drugs and other exogenous toxins, total 








1 


- 


1 


Other exogenous toxins 








— 


— 


— 


11. Psychoses with pellagra 








2 




2 


12. Psychoses with other somatic diseases, total ...... 


. . . . 






5 




20 


Delirium with infectious diseases 




"2 


" '3 








Delirium of unknown origin 




6 


7 








Cardio-renal diseases 


2 


1 


3 








Other diseases or conditions 


1 


6 


7 








13. Manic-depressive psychoses, total 








2 


18 


20 


Manic type 




io' 


io' 








Depressive type 


2 


6 


8 








Other types 




2 


2 








14. Involution melancholia 








1 


5 


6 


15. Dementia praecox (schizophrenia) 








8 


10 


18 


16. Paranoia and paranoid conditions 








1 


3 


4 


17. Epileptic psychoses 








1 




1 


18. Psychoneuroses and neuroses, total 














19. Psychoses with psychopathic personaUty 














20. Psychoses with mental deficiency 














21. Undiagnosed psychoses 








6 


3 


9 


22. Without psychosis, total 














Total 




63 


59 


122 



P.D. 137 39 
Table 7. Race of First Admissions Classified with Reference to Principal Psychoses 





















With 










Race 




Total 


Traumatic 


Senile 




cerebral 




General 




















arterio- 




paralysis 




















sclerosis 












M. 


F. 


T. 


M. 


F. 


T. 


M. F. 


T. 


M. F. T. 


M. 


F. 


T. 


African (black) 


2 


2 


4 
















1 


- 


r 


English 


5 


8 


13 


- 


- 


- 


- 1 


1 






2 


— 


2 


French 




1 


2 
















1 


- 


J 




1 


1 


2 
















J 






Greek 


1 




I 
















1 




1 


Hebrew 


4 


5 


9 
















2 


- 


2 


Irish 


17 


17 


34 


- 


1 


1 










6 




6 


Italian' ..... 


4 




4 
















3 




3 


Portuguese 


1 




1 






















Scandinavian * . 


4 


2 


6 
















1 




1 




5 


5 


11 












1 - 


1 


3 




3 


Slavonic • 


3 




3 
















1 




1 






1 


1 






















Mixed 


13 


16 


29 












1 


1 


8 




8 


Unascertained .... 


1 


1 


2 
















1 




1 


Total 


63 


59 


122 




1 


1 


1 


1 


1 1 


2 


31 




31 



Table 7. Race of First Admissions Classified with Reference to Principal 
Psychoses — Continued. 









With other 


Due to drugs 










With 






With 


With brain 


brain or 




and other 




With 






other 




Race 


cerebral 


tumor 


nervous 




exogenous 


pellagra 


somatic 




syphilis 




diseases 




toxins 








diseases 




M. F. T. 


M. F. T. 


M. 


F. T. 


M. F. T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black) 










1 




1 




1 








English . 






















3 


3 


French . 


























German . 






















1 


1 


Greek . 


























Hebrew 






















2 


2 


Irish 










1 


1 - 1 


1 




1 


3 


4 


7 


Italian!. 


























Portuguese . 






1 




1 
















Scandinavian » 




1 - 1 


















1 




Scotch . 










1 










1 


1 


2 


Slavonic * 




















1 






Spanish 






















1 




Mixed 






















2 


2 


Unascertained 


























Total 


1 - 1 


1 - 1 


2 


2 


4 


1 - 1 


2 




2 


5 


15 


20 



'Includes "North" and "South". 
'Norwegians, Danes and Swedes. 

'Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



40 



P.D. 137 



Table 7. Race of First Admissions Classified iviih Reference to Prind-pal 
Psychoses — Contrnwed.. . . , „ 



Race 


Manic- 
depressive 


Involution 
melancholia 


Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


Epileptic 
psychoses 


Undiagnosed 
psychoses 


































M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


Sol. 




T 


M. 


r . 1 . 


M. 


F. 


T. 


African (black) 


















1 


















English . 




1 


1 






~ 


3 


1 


4 


- 


1 


1 


- 


- - 


- 


1 


1 


French . 


- 


1 


1 






























Greek 




































Hebrew 




2 


2 


1 


1 


2 






1 


















Irish 




7 






2 


2 


1 


2 


3 


1 


1 


2 


1 




2 




2 


Italian i 














1 






















Portuguese . 




































Scandinavian ^ 




1 


1 








1 




1 


















Scotch . 




2 


2 




1 


1 


















1 




1 


Slavonic ' 






























1 




1 


Spanish 




































Mixed 


2 


3 


5 






1 


1 


6 


7 




1 








2 


2 


4 


Unascertained 




1 


1 






























Total 


2 


18 


20 


1 


5 


6 


8 


10 


18 




3 


4 


1 


- 1 


6 


3 


9 



^Includes "North" and "South". 
^Norwegians, Danes and Swedes. 

'Includes Bohemian. Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moragian, Polish, 
Russion, Ruthenian, Servian. Slovak, Slovenian. 



Table 8. Age of First Admissions Classified with Reference to Principal 

Psychoses. 



Psychoses 




Total 


Under 
15 years 


15-19 
years 


20-24 
years 


25-29 
years 




M. 


F. 


T. 


M. F. T. 


M. F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic .... 




1 


1 




















2. Senile 




1 


1 




















3. With cerebral arteriosclerosis 


1 


1 


2 




















4. General paralysis . . 


31 




31 




1 - 


1 








2 




2 


5. With cerebral syphilis . 


1 




1 




















6. With Huntington's chorea .' 


























7. With brain tumor . 


1 




1 




1 -. 


1 














8. With other brain or nervous 




























2 


2 


4 










1 


1 


1 




1 


9. Alcoholic 


























10. Due to drugs and other exog- 


1 




1 




















enous toxins 






















11. With pellagra .... 


2 




2 




















12. With other somatic diseases . 


5 


15 


20 










1 


1 




4 


4 


13. Manic-depressive 


2 


18 


20 




- 1 


1 




4 


4 


1 


6 


7 


14. Involution melancholia . 


1 


5 


6 






















8 


•10 


18 






5- 




. 3 


3 


3 


3 - 


6 


15. Dementia praecox ; . 

16. Paranoia and paranoid condi- 


























1 


3 


4 




















17. Epileptic psychoses. 


1 




1 








1 




1 








18. Psychoneuroses and neuroses . 


























19. With psychopathic personality 


























20. With mental deficiency . 


























21. Undiagnosed psychoses . 


6 


3 


9 




1 1 


2 


3 




4 








22. Without psychosis . 


























Total 


63 


59 


122 




6 4 


10 


4 


10 


14 


7 


13 


20 



P.D. 137 



41 



Table 8. Age of First Admissions Classified uith Reference to Princifcl 
Psychoses — Continued. 



Psychoses 


30-34 
years 


35-39 
years 


40-44 
years 


45-49 
years 


50-54 
years 


1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis . 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor . 

8. With other brain or nervous 

diseases .... 

9. Alcoholic 

10. Due to drugs and other ex- 

ogenous toxins . 

11. With pellagra. 

12. With other somatic diseases. 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia and paranoid con- 

ditions .... 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic person- 

ality 

20. With mental deficiency 

21. Undiagnosed psychoses. 

22. Without psychosis. 

Total 


M. F. T. 

2-2 
1 - 1 

- 1 1 

1 4 5 

- 4 4 


M. F. T. 

8-8 

1 - 1 
1 - 1 

- 2 2 
2-2 

1 1 

- 1 1 


M. F. T. 
4-4 

1 - 1 
1 1 2 

- 1 1 

- 1 1 

- 2 2 

- 1 1 


M. F. T. 

5-5 

- 4 4 

- 3 3 

1 1 2 


M. F. T. 

- 1 1 
6-6 

1 - 1 

1 - 1 

1 1 2 

2 - ' 2 


4 9 13 


12 4 16 


6 6 12 


6 8 14 


11 2 13 


Table 8. Age of First Admissions Classified -unth Reference to Principal 
Psychoses — Concluded. 


Psychoses 


55-59 
years 


60-65 
years 


65-69 
years 


70 years 
and over 


1. Traumatic 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis 

6. With Huntington's chorea .... 

7. With brain tumor 

8. With other brain or nervous diseases . 

9. Alcoholic 

10. Due to drugs and other exogenous toxins . 

11. With pellagra 

12. With other somatic diseases .... 

13. Manic-depressive 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic peronality 

20. With mental deficiency ... 

21. Undiagnosed psychoses 

22. Without psychosis 

Total 


M. F. T. 

1 - 1 
3-3 

1 1 2 


M. F. T. 


M. F. T. 
- 1 1 

1 - 1 


M. F. T. 
- 1 1 

1 - 1 


5 1 6 




1 1 2 


1 1 2 



42 



P.D. 137 



§3 



c_ 

o o 
E 2 



i <N 1 

I I I 



> I I 

I <N I 
I O' I 
I I I 
I Ov I 
— — «N >C — 



I I I I I I I I I 

I I I I I I I I I 

1 I — I — I I I 

I I 1 ^ I I I 

I I I I I I I I I 

1 I I 00 1 I 

I I vOoo I r»f^ I I 

— CN CS O C — — « I 
I I 00 0«D CS I 1 I 

— tN-* 1 — t^ — -< I 



I I 



I I X lO C I 



o 
o c 



5 



2 2 2 = 



■ ■ T3 ■ 4; I- >> ?, ■ 

;|x2il-^-^-S.= 

^ = S rt o >• S 

i3 H c.^ 50 •5; 4^ S 9 

n J; 5?P o^?. >> 



^ = :5 •- ^ •£ -2 ^ •- ^ ^ = 



P.D. 137 



43 



Table 10. Environment of First Admissions Classified with Reference to 
Principal Psychoses. 



Psychoses 




Tota 


1 


Urban 


Rural 


Unascer- 
tained 


1. Traumatic 

2. Senile 

3. Witii cerebral arteriosclerosis . 

4. General paralysis 

5. With cerebral syphilis .... 

6. With Huntington's chorea 

8. With other brain or nervous diseases . 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases . 

13. Manic-depressive 

14. Involution melancholia .... 

16. Paranoia and paranoid conditions. 

18. Psychoneuroses and neuroses. 

19. With psychopathic personality 

20. With mental deficiency .... 

21. Undiagnosed psychoses .... 

22. Without psychosis 

Total 


M. 

1 
31 

1 

2 

1 

2 
5 
2 
1 
8 

6 


F. 
1 

2 

15 
18 

5 
10 

3 

3 


T. 

1 
1 
2 
31 
1 

1 
4 

1 
2 
20 
20 
6 
18 
4 
1 

9 


M. F. T. 

- 1 1 
1 1 
1 1 2 
31 - 31 

1 - 1 

2 2 4 

1 - 1 
2-2 

5 14 19 

2 18 20 
1 5 6 
8 10 18 
1 3 4 
1 - 1 

6 3 9 


M. F. T. 
- 1 1 


M. F. T. 
1 - 1 


63 


59 


122 


62 58 120 




1 - 1 


Table 11. Economic Conditions of First Admissions Classified with Referencp to 

Principal Psychoses. 


Pyschoses 




Tota 


1 


Dependent 


Margined 


Unascer- 
tained 


2. Senile 

3. With cerebral arteriosclerosis . 

4. General paralysis 

5. With cerebral syphilis .... 

6. With Huntington's chorea 

7. With brain tumor 

8. With other brain or nervous diseases . 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases . 

14. Involution melancholia .... 

15. Dementia praecox 

16. Paranoid and paranoid conditions. 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency .... 

21. Undiagnosed psychoses .... 

22. Without psychosis 

Total 


M. 

1 
31 
1 

1 

2 

2 
5 
2 
1 
8 
1 
1 

6 


F. 

1 
1 
1 

2 

15 
18 

5 

10 
3 

3 


T. 
1 

1 

2 
31 
1 

1 
4 

1 

2 
20 
20 

6 
18 

4 

1 

9 


M. F. T. 

1 1 
1 - 1 

1 1 

- 1 1 

- 1 1 
1 - 1 

1 - 1 


M. F. T. 

1 1 

1 1 2 
30 - 30 

1 - 1 

2 2 4 

1 - 1 

2-2 
5 14 19 

2 17 19 
1 5 6 
8 9 17 
1 3 4 

5 3 8 


1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 ^ 1 1 1 1 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 


63 


59 


122 


3 4 7 


59 55 114 


1 - 1 



44 



P.D. 137 



Table 12. Use of Alcohol by First Admissions Classified with Reference to 

Principal Psychoses. 



P5YCH05ES 




Total 


Abstinent 


Temperate 


Intemperate 


Unascer 




























tained 






M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


M. 


F. 


T. 


1. Traumatic .... 


— 


1 


1 


— 


1 


1 


















2. Senile 


- 


1 


1 


— 


1 


1 


















3. With cerebral arterio- 






























sclerosis .... 


1 


1 


2 


- 


1 


1 


- 


- 


- 


1 


1 






- 


4. General paralysis 


31 


— 


31 


9 


— 


9 


13 


— 


13 


8 


- 8 


1 




1 


5. With cerebral syphilis 


1 


— 


1 


- 


- 


- 


1 


- 


1 


- 


- _ 






- 


6. With Huntington's chorea 






























7. With brain tumor 


1 


— 


1 


1 


— 


1 


















8. With other brain or nerv- 






























ous diseases 


2 


2 


4 


- 


2 


2 


2 


- 


2 












9. Alcoholic .... 






























10. Due to drugs and other ex- 






























ogenous toxins 


1 


— 


1 


— 


— 


— 


— 


— 


— 


1 


1 






— 


11. With pellagra 


2 


— 


2 


— 


— 


— 


— 


— 


— 


2 


2 






- 


12. With other somatic diseases 


5 


15 


20 


1 


12 


13 


2 


1 


3 


1 


2 3 


1 


z 


1 


13. Manic-depressive 


2 


18 


20 


2 


16 


18 


- 


1 


1 


- 


- - 




1 


1 


14. Involution melancholia 


1 


5 


6 




c 

a 


5 


1 




1 






: 






15. Dementia praecox 


8 


10 


18 


5 


7 


12 


2 


3 


5 


1 


1 








16. Paranoia and paranoid 






























conditions 


1 


3 


4 




3 


3 








1 


- 1 






- 


17. Epileptic psychoses . 


1 




1 


1 




1 


















18. Psychoneuroses and neu- 






























roses .... 






























19. With psychopathic per- 






























sonality .... 






























20. With mental deficiency . 






























21. Undiagnosed psychoses . 


6 


3 


9 


2 


3 


5 


2 




2 


2 


- 2 








22. Without psychosis 






























Total .... 


63 


59 


122 


21 


51 


72 


23 


5 


28 


17 


2 19 


2 


1 


3 



Table 13. Marital Condition of First Admissions Classified with Reference to 

Principal Psychoses. 



Psychoses 




Tota 




Single 


Married 


Widowed 


Separated 


Divorced 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


1. Traumatic . 




1 


1 














- 1 1 






2. Senile .... 




1 


1 














- 1 1 






3. With cerebral arterio- 


























sclerosis . 


1 


1 


2 




1 


1 


1 




1 








4. General paralysis 


31 




31 


13 




13 


17 




17 




1 - 1 




5. With cerebral syphilis 


. 1 




1 








1 




1 








6. With Huntington's cho- 


























rea .... 


























7. With brain tumor 


1 




1 


1 




1 














8. With other brain or 


























ner\'ous diseases 


2 


2 


4 








2 


2 


4 








9. Alcoholic 


























10. Due to drugs and other 








1 




1 














exogenous toxins 


1 




1 
















11. With pellagra 


2 




2 








2 




2 








12. With other somatic dis- 


























seases 


5 


15 


20 


2 


1 


3 


1 


13 


14 




1 1 2 


1 - 1 


13. Manic-depressive 


2 


18 


20 


1 


13 


14 




4 


4 


1 - 1 


- 1 1 




14. Involution melancholia 


1 


'5 


6 








1 


5 


6 








15. Dementia praecox 


8 


10 


18 


6 


9 


15 


2 


1 


3 








16. Paranoia and paranoid 


























conditions 


1 


3 


4 


1 


2 


3 












- 1 1 


17. Epileptic psychoses 


1 




1 


1 




1 














18. Psychoneuroses and 


























neuroses . 


























19. With psychopathic per- 


























sonality 


























20. With mental deficiency 


























21. Undiagnosed psychoses 


6 


3 


9 


6 


2 


8 




1 


1 








22. Without psychosis 


























Total 


63 


59 


122 


32 


28 


60 


27 


26 


53 


1 2 3 


2 2 4 


1 1 2 



P.D. 137 



45 



Table 14. Psychoses of Readmissions 

Psychoses Males 

General paralysis 3 

Psychoses with other brain or nervous diseases 1 

Psychoses due to drugs and other exogenous toxins 1 

Manic-depressive i>sychoses 3 

Dementia praecox 1 

Undiagnosed psychoses 1 

Total 10 



Females 



Total 
3 
1 
1 
8 
2 
2 

17 



Table 15. Discharges of Patients Classified with Reference to Principal Psychoses 

and Condition on Discharge 



Psychoses 




Total 




Recovered 


Improved 


Unimproved 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


With cerebral arteriosclerosis .... 


2 




2 








2 




2 








General paralysis 


10 




10 








10 




10 








With cerebral syphilis 




1 


1 










1 


1 








With other brain or nervous diseases 


3 




3 








3 




3 








Alcoholic 


1 




1 








1 




1 








Due to drugs and other exogenous toxins 


1 




1 








1 




1 








With other somatic diseases .... 


1 


4 


5 


1 


2 


3 




1 


I 




1 


1 




1 


12 


13 




2 


2 


1 


9 


10 




1 


1 


Dementia praecox 


5 


5 


10 




1 


1 


4 


3 


7 


1 


1 


2 


With psychopathic personality 




1 












1 


1 








Undiagnosed psychoses 


5 


4 


9 


1 


1 


2 


4 


3 


7 








Total 


29 


27 


56 


2 


6 


8 


26 


18 


44 


1 


3 


4 



46 P.D. 13'; 

Table 16. Causes of Death of Patients Classified with Reference to Principal 

Psychoses 













With cerebral 




Causes of Death — Diseases 




Total 


Senile 


arterio- 


General 












sclerosis 


paralysis 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


Epidemic, Endemic and Infectious 












Tuberculosis of respiratory system . 


1 




1 


_ _ _ 


1 - 1 


_ _ _ 


Syphilis (non-nervous forms) .... 


1 




I 


_ _ _ 


- 


_ _ _ 


Purulent infection, septicaemia 


1 




1 








General — Not Included in Class I 














Cancer and other malignant tumors 


— 


1 


1 








Alcoholism (acute or chronic) 


1 




1 


_ _ _ 


- 


_ _ _ 


Other general diseases 


— 


1 


1 








Of the Nervous System 














General paralysis of the insane .... 


3 




3 






3-3 


Other forms of mental disease .... 


1 


3 


4 










1 




1 








Other diseases of the nervous system 


1 




1 








Of the Circulatory System 
















1 


2 


3 


- - - 


1 - 1 


- - - 


Of the Respiratory Syestm 














Of respiratory system (tuberculosis excepted) 


1 




1 








Non-Venereal — Genito- Urinary System and 














A.nnexa 


















1 


1 








Of the Skin and Cellular Tissue 














Diseases of skin and annexa .... 


2 




2 






1 - 1 


External Causes 














Other external causes 




1 


1 


- 1 1 






Total 


14 


9 


23 


1 1 


2-2 


4-4 


Table 16. Causes of Death of Patients Classified with Reference to Principal 


Psychoses — 


- Concluded. 






Causes of Death — Diseases 


Alcoholic 


Involution 


Epileptic 


lAll other 










melancholia 


psychoses 


psychosis 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


Epidemic, Endemic and Infectious 














Tuberculosis of respiratory system . 














Syphilis (non-nervous forms) .... 












1 - 1 


Purulent infectious, septicaemia 












1 - 1 


General — Not Included in Class I 














Cancer and other malignant tumors . 












- 1 1 


Alcoholism (acute or chronic) .... 












1 - 1 


Other general diseases 












- 1 1 


Of the Nervous System 














General paralysis of the insane .... 














Other forms of mental disease .... 








- 1 1 




1 2 3 












1 - 1 




Other diseases of the nervous system. 












1 - 1 


Of the Circulatory System 












- 2 2 


Arteriosclerosis 












Of the Respiratory System 














Of the respiratory system (tuberculosis excepted) 


1 




1 








Non-Venereal — Genito-Urinary System and 














Annexa 


























- 1 1 


Of the Skin and Cecullar Tissue 














Diseases of the skin and annexa 












1 - 1 


External Causes 






























1 




1 


1 1 


1 - 1 


6 7 13 



^Includes group 22, "without psychosis. 



P.D. 137 



47 




48 



P.D. 137 



09 



C6 



9 -o 
in ^ 



5 >, 



Ok » 

L 111 



3~ 



o=:j= o o g 



._. o ■— > r^. e 



P.D. 137 



49 



Fable 18, Total Duration of Hospital Life of Patients Dying in Hospital Classified 
According to Principal Psychoses 



Psychoses 




Tota 




Less than 
1 month 


1-3 
months 


4-7 
months 




M. 


F. 


T 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


rraumatic ...... 




1 


1 










1 


1 








Eenile 




1 


1 




1 


1 














With cerebral arteriosclerosis 


2 




2 








1 




1 


1 




1 


^neral paralysis .... 


4 


_ 


4 


3 




3 








1 




1 


iVith cerebral syphilis . 


1 




1 








1 




1 








A'^ith brain tumor 


1 


- 


1 








1 




1 








Alcoholic ..... 


1 




1 


1 




1 














IVith pellagra .... 


1 




1 


1 




1 














W^ith other somatic diseases 


2 


5 


7 


2 


4 


6 










1 


1 


nvolution melancholia. 




1 


1 




1 


1 














epileptic psychoses 


1 




1 








1 




1 








Jndiagnosed psychoses 


1 


1 


2 


1 


1 


2 














Total 


14 


9 


23 


8 7 15 


4 


1 


5 


2 


1 


3 



Public Document 




ANNUAL REPORT 



TRUSTEES 



Boston Psychopathic 



Hospital 



Year exdixg XovEMr.ER 30, 1930 



Depaktment of Mental Diseases 



MafTachufetrs 
Tercentenary 



Publication of this Document approved bv the Commission on Administration and Finance 
600— 5-'31. Order 1969. 



OCCUPATIONAL PRINTING PLANT 
DEPARTMENT OF MENTAL DISEASES 
GARDNER STATE COLONY 
GARDNER. MASS. 



BOARD OF TRUSTEES 
William Healy, M.D., Chair many Boston. 
Mrs. Esther M. Andrews, Secretary, Brookline. 
Carrie I. Felch, M.D., Bostorij ftptaTS 
Channing Frothingham, M.D.,' Boston. 
Allan W. Rowe, Ph.D., Boston. 
William J. Sullivan, Boston. 
Charles F. Rowli:y, Boston. 

CONSULTING PHYSICIANS 
E. B. GooDALL, M.D., Ophthalmologist. 
G. Philip Grabfield, M.D., Internist. 
Leon E. White, M.D., Oio-Laryngologist. 
Abraham Myerson, M.D., Neurologist. 

E. B. Sheehan, M.D., Gynecologist. 

The staffs of adjoining hospitals. 

OFFICERS OF THE HOSPITAL 
C. Macfie Campbell, M.D., Medical Director. 
Arthur N. Ball, M.D., Chief Executive Officer. 
Karl M. Bowman, M.D., Chief Medical Officer. 
Frank J. Curran, M.D., Senior Physician. 
G. Philip Grabfield, M.D., Senior Physician. 
John P. Powers, M.D., Senior Physician. 
Oscar J. Raeder, M.D., Senior Physician. 
'Harry C. Solomon, M.D., Senior Physician. 
Irma a. Bache, M.D., Assistant Physician. 
Janet S. Barnes, M.D., Assistant Physician. 
Geokge M. Lott, M.D, Assistant Physician. 
Randall McLean, M.D., Assistant Physician. 
Mary Palmer M.D., Assistant Physician. 
Charles B. Sullivan, M.D., Assistant Physician. 
Robert E. Britt, M.D., Medical Interne 
Jacob Conn, M.D., Medical Interne. 
Geqrge S- Goldman, M.D., Medical Interne, 

, Chief of Neuropathological Laboratory. 

Marjorii: Fulstow, M.D., Acting Chief of Neuropathological Laboratory.^ 
Whitman K. Coffin, M.D., Roentgenologist. 
Peter J. Dalton, D.M.D., Dentist. 

F. L. "^ELLs, Ph.D., Head Psychologist. 

Mary Fitzgerald, Principal of School of Nursing. 

Esther C. Cook, Head Social Worker. 

Ethelw yn F: Humphrey, Head Occupational Therapist. 

Mrs. Et.veretta Blake, Librarian. 

Elizabeth Libber, Treasurer. 

iBy arrangement with the Department of Mental Diseases 



CONTENTS 

Report; of TruptPPP 3 

Report of Medical Director 3 

Rt^port of Out-Patient Department 18 

Report of Chiff Medical Officer 23 

Report of BiocLemical Laboratory 25 

Report of Psychological Laboratory 26 

Report of Neuropathological Laboratory 28 

Report of Department of Therapeutic Research 28 

Report of Chief Executive Officer 30 

Report of Social Service Department 32 

Report of Superintendent of Nurses 36 

Report of Department of Occupational Therapy 38 



Ir.D. 137 ' 3 

REPORT OF THE TRUSTEES OF THE BOSTON PSYCHOPATHIC 

HOSPITAL 

To His Excellency the Governor and the Honorable Council: 

The Trustees would call attention to this report of 1930 as representative of the 
work of another busy year at the Boston Psychopathic Hospital. The clinical 
study of 1,900 patients by the methods that take into account the many possible 
and often very complicated factors that enter into the production of mental symp- 
toms and personality disorders involves an immense task. From observations and 
routine visits there, and from the reports received at the regular monthly meetings, 
the Trustees believe that the work continues to be of very high calibre. Consider- 
ing the complicated nature of the problems presented, the great numbers of patients 
that are seen, the changes in the professional staff that occur from time to time, 
and the limitation of funds, it is obvious to us that the level of the work has been 
splendidly maintained. We have every reason to confirm the high regard in which 
the hospital is held nationally and even internationally. 

That the work with so many difficult patients continues year after year with such 
a minimum of difficulty arising is due particularly to the skilful management of 
the medical director, the chief executive officer, and the chief of medical service, 
as they are all encouraged by the attitude of the Commissioner of the Department 
of Mental Diseases. In turn, they appear to imbue the whole personnel with a 
spirit of co-operative service. Once more we assert that the Commonwealth of 
Massachusetts is deeply indebted to these officers for the fine spirit which they 
display. 

We would add our fervent hope to that expressed by our medical director for 
extension of research into the great and baffling scientific and human problem of 
mental disease. We are grateful for the special funds which have been attracted 
through the professional standing and capacity of the staff, funds which have led 
to the special studies that have been carried on, but it is evident that greater re- 
sources are necessary if the hospital is to develop, as it should, into one of the most 
notable centers for the scientific investigation of mental ailments — one of the 
greatest scorges of mankind. 

There are several outstanding activities of the hospital which could be pointed 
out as distinctive continuing achievements. These should appear obvious to the 
reader of this report, but we would this year like to make special mention of the 
success of the co-operative training of nurses, which, in turn, means better service 
to the community through more nurses being acquainted with the needs of the 
mentally ill. This is merely one of the fields in which the hospital is functioning 
co-operatively. The fact is that mental ailments have many complications in- 
volving the family, economic, educational, and social life of the individual as well 
as his physical and psychological conditions. Interdependence and inter-relation 
ship of all these have to be considered both in studying the causation of the disorder 
as well as in making plans for treatment. Besides the work done in the hospital 
itself, co-operation with families, courts, social agencies, employers, and schools 
is necessary. The medical director's reports, and especially his short sketches of 
cases show how well this is kept in mind. 

Respectfully submitted, 
William Healy, Chairman. Allan Winter Rowe 

Esther M. Andrews, Secretary. William J. Sullivan, 

Carrie Innes Felch, Channing Frothingham, 

Charles F. Rowley. 

MEDICAL DIRECTOR'S REPORT 

December 11, 1930. 

To the Board of Trustees of the Boston Psychopathic Hospital: 

In accordance with the provision of the statutes I submit for your consideration 
the report for the statistical year ending September 30, 1930, and for the fiscal 
year ending November 30, 1930. 



4 



P.D. 137 



On the General Work of the Hospital 

In previous annual reports some attention has been paid to the general organiza- 
tion of the work in the hospital; an outline has been given of the various functions 
of the hospital, of its various departments and of the coordination of the various 
activities in the hospital. The three main functions of the hospital are (1) the care 
and treatment of the patients confided to it; (2) investigation into the causes of 
mental disorders and into the best way of dealing with them; (3) the teaching of 
various groups of special students. 

The combination of these three functions has many advantages but at times the 
demands made upon one function may somewhat interfere with the fulfillment of 
another. The demand made upon the medical staff by the very large number of 
patients admitted is so absorbing that there is less time for investigative work 
than one could desire. In addition, the very limited budget which is available for 
investigative work makes it impossible to take advantage of the unusual oppor- 
tunities for research and to follow up promising lines of inquiry. For the hospital 
to fulfill its function of research in any adequate way, structural additions and a 
larger budget for research are necessary. 

Even under the present limitation of facilities at the hospital, investigative work 
has been steadily carried on during the past year, and references will be made to 
this work later in the report. 

The number of patients admitted to the hospital during the past year, the types 
of disorder dealt with, the variety of clinical problems presented, the special ques- 
tions of treatment which have arisen have not differed essentially from the material 
of the preceding year. It is not generally realized even by the medical profession 
how much time is taken up in the examination, the diagnosis, the treatment of 
even the simplest case of mental disorder. In certain medical specialties attention 
may be, without danger, focussed upon a special organ or system, and treatment 
directed almost immediately to that system. In the field of mental disorders the 
problem is more complex. The symptoms for which the patient is brought to the 
hospital can only rarely be looked upon as due to the disorder of a single system, 
and in general have to be considered from a wider point of view as a problem in 
human adjustment. The psychiatrist has to make a thorough review of his patient, 
not only of the basal functions such as circulation, digestion, excretion, but also of 
the instinctive and the emotional life and of the general problem of the adaptation 
of the patient with his special personality to the actual life situation which he has 
to meet. 

In view of the large admission rate and of the unusually heavy demands made 
upon the time of each house physician for the examination of a single patient, only 
a limited number of the patients admitted can be studied intensively over any 
considerable period. Yet it is chiefly from such intensive study of cases that pro- 
gress in our knowledge of the intimate mechanisms of mental disorders is to be 
expected. It is one of the practical problems of the hospital to choose judiciously 
from the large number of patients admitted those cases where intensive study and 
treatment are likely to be most productive. 

It has been the custom in previous annual reports to give brief sketches of indi- 
vidual cases in order to illustrate the actual problems dealt with at the hospital, 
and to give some human content to the abstract diagnostic terms of the statistical 
tables. These alien diagnostic terms do little justice to the homely nature of the 
problems of the patient, and do not reveal how near these problems of the patients 
are to the stresses and conflicts which enter into the private life of everyone. 

In many cases the problem is a strictly medical one in the narrow technical sense 
of the word medical; in other cases the physician has to deal with a problem of 
human adaptation, where studies in nutrition and infection play a meagre role, 
while the analysis of the personality and of the life situation is in the centre of his 
task. The cases of more strictly medical nature are not necessarily those whose 
symptoms are predominantly physical nor are mental symptoms the only way in 
which the difficulty of adaptation to the stresses of life may be expressed. Eccentric 
conduct or a disconcerting attitude may be the first indication of some underlying 
bodily ailment, and on the other hand paralysis or pain may have its origin in the 



P.D. 137 



5 



difficulty which the patient has in meeting a distressing social situation. A few 
examples to illustrate these general principles follow. 

(A) Cases of organic disease of the central nervous system manifesting itself either 
physical or menial symptoms or in both. 

A. B., a woman of 57 for 3 years had shown rather childish behaviour. More 
recently she had become dizzy and complained of other disturbing feelings; finally 
she became confused and complained of smelling various odors and hearing noises 
which others did not hear. Examination disclosed the presence of a brain tumor 
and she was transferred to another hospital to be under surgical care. 

B. C., aged 48, a civil service employee doing important work, had for some time 
shown a complete change in his personality but no physical symptoms had been 
noticed by his family. Examination disclosed the presence of general paralysis 
("paresis") and he was given special treatment with very marked benefit. He has 
been enabled to return to his occupation and is maintaining his previous level of 
efficiency. 

CD., aged 46, had complained that people were after him, he heard voices making 
accusations against him and stated that he had been chloroformed. On account 
of sexual misbehaviour he was brought into court and was referred to the hospital. 
Examination disclosed physical signs which were very suggestive of general paralysis 

D. E., a boy of 15, had been causing much trouble by his wilful and disorderly 
behaviour and had come to the attention of the police owing to stealing. He was of 
normal intelligence, showed no outstanding physical symptoms but the examination 
of his cerebrospinal fluid showed anomalies pointing towards some organic involve- 
ment of the central nervous system. 

E. F., a boy of 19 was referred by the court as he has assaulted another boy with a 
knife. A review of his general condition disclosed physical symptoms suggestive 
of epidemic encephalitis, a disease which may leave not only persistent physical 
symptoms but serious changes in the personality. 

In other cases the underlying cause of the disorder is not a structural change 
such as brain tumor or abscess but a disturbance of the nutrition of the brain, either 
owing to some chronic or acute poisoning or to some general bodily ailment with 
secondary interference with the function of the brain. Of the cases due to chronic 
or acute intoxication, the most frequent are those due to alcoholism. In some cases 
the mental disturbance is of transitory nature, but in other cases permanent damage 
has obviously been done and the patient may suffer from a permanent and serious 
loss of memory with all that this entails, or from a permanent distortion of the 
mental life in which hallucinations and delusions play an important role. 

(B) Cases of mental disorder based on some form of poisoning. 

F. G., aged 52, addicted to the use of alcohol, became suspicious of her husband 
and thought that he was trying to poison her. On admission to the hospital she 
was nervous and restless, had both visual and auditory hallucinations, and after 
8 days in the hospital was transferred for continued treatment elsewhere. 

G. H., aged 45, for some months had been showing motor symptoms. He finally 
became confused and excited, imagined that people were going to harm him. He 
saw imaginary persons and heard imaginary voices. The condition seemed to be 
due to the fact that he had been taking bromoseltzer in large quantities. After 
one month in the hospital he had recovered and was able to leave. 

Mental symptoms occur in the greatest variety of physical disorders and either 
owing to special difficulty in management or to the vague apprehension of those in 
charge of the patient the latter may be admitted to the Boston Psychopathic 
Hospital rather than to a general hospital, or transferred from the latter to the 
former. 

(C) Cases of mental disorder due to physical ailments. 

H. I., aged 29, a previously well balanced and pleasant young woman. Eight 
days after the birth of a baby became restless and excited and preoccupied with 
religious matters. On admission to the hospital she was found to be under-nourished 
and anemic, with a very slight fever, and was in a condition of marked mental 
confusion. Under the routine medical and nursing care she steadily improved and 
was able to leave the hospital 3 weeks after admission. 



6 



P.D. 137 



I.J., aged, 23 complained of being exhausted, faint, tired and worried. In this 
case the physical health of the patient was not satisfactory but it seemed probable 
that the nature and degree of her incapacity were partly determined by her person- 
ality and her way of dealing with problems of life. She was referred to another 
hospital for tonsillectomy and gynecological treatment and arrangements were 
made for her to return for psychotherapy to the Out-Patient Department of the 
Boston Psychopathic Hospital. 

In many cases no evidence of any undermining disorder is found and the morbid 
ideas of the patient seem closely connected with the instinctive and emotional needs 
of the patient and with the subtle influences of the family and social atmosphere. 

(D) Cases in u^hich the menial symptoms are the response of a vulnerable personality 
to an unsatisfactory life situation. 

J.K., aged 20, on admission showed a considerable degree of under-nourishment 
but no specific physical disorder. She had been brought up in a strict orthodox 
Jewish home. For some time she had lost interest in her clerical occupation and 
had become more and more preoccupied with phantasies until she saw the whole 
world distorted by her preoccupations and her wishes. She felt that men had pro- 
posed marriage to her and that she was going to have a baby. 

K.L., aged 36, a simple Irish woman. Had been preoccupied with religion to a 
morbid degree and had shown eccentric behaviour. She told of many complicated 
and phantastic experiences and spent much time in praying. Owing to the absence 
of relatives it was not possible to get any detailed account of her life nor to trace 
the relationship between her beliefs and the conditions of her rather lonely and 
drab existence. 

L.M., aged 32, for some months had episodes of being suspicious of his wife after 
which he would recognize the unjustness of his suspicions. The father of the patient 
had committed suicide as a result of domestic troubles and his mother had been 
very jealous. The patient presented in an exaggerated degree an attitude which 
in a less degree is of frequent occurrence. He was unwilling to stay long enough in 
the hospital to have a thorough review made of the complicated factors which are 
usually found at the basis of morbid jealousy. 

M.N., aged 19, a Lithuanian boy who had been living for many years with his 
father with whom he was not on good terms and whom he held responsible for in- 
considerate treatment of his dead mother. Although the boy was of normal in- 
telligence, he had been unable to establish himself in any occupation and was 
apparently devoid of social interests. It was considered that for the re-education of 
this boy in social adaptation a rather prolonged period of treatment in a state 
hospital would be required. 

Depression is one of the most common features in all mental disorders and in 
some cases it dominates the whole clinical picture. The depression may be of varied 
nature and degree; it may occur in personalities of varied types; it may be pre- 
cipitated by a great variety of factors. 

(E) Cases of depression or elation elicited by a variety of difficulties, of long or short 
duration. 

N.O., aged 38, had reacted to prolonged unemployment with depression and 
finally had made an impulsive attempt at suicide. He was transferred to a U.S.V.B. 
Hospital for continued treatment. 

O.P., aged, 43, became depressed after financial losses. He lost hope and at- 
tempted suicide. He felt that he was going to be electrocuted. The case seemed to 
be one where complete recovery could be expected. He was transferred to a 
U.S.V.B. Hospital. 

P.Q., aged 47, became depressed over financial losses and over the illness of his 
wife, as a result of which he had been living alone and probably been rather poorly 
nourished. A short period of rest in the hospital with encouraging interviews and 
psychotherapy led to considerable improvement so that he was able to return home. 
The improvement, however, was not maintained for long so that after one month 
he was taken to another hospital for treatment. 

Q.R., aged 51, for many years had suffered from the unkindly and overbearing 
treatment of her husband. The additional factors which led to her depression were 
the mental disorder of her son and an attack of bladder trouble. 



P.D. 137 



7 



In these cases the episode of depression is caused by some reverse or disappoint- 
ment but in other cases there is the rather paradoxical reaction where a disappoint- 
ment elicits an attack characterized by elation and overactivity. 

R.S., aged 23, had been rather pampered from childhood owing to a certain 
physical ailment. At the age of 21, after breaking an engagement, she had been 
somewhat excited and elated. The present attack, which was characterized by 
elation and overactivity, had been apparently precipitated by difficulties placed 
in the way of her marriage by her family. 

Many patients are referred to the court where no indication of physical disorder 
is found but where the misconduct requires for its explanation a searching review 
of the past life of the patient and of the influences to which he has been subject. 
Such a review requires not only much time but also the full cooperation of the 
patient. 

(F) Cases with need of personal guidance on account of misconduct or other symp- 
toms. 

S.T., aged 14, a pleasant and intelligent boy who was brought to the hospital 
from the court as he had been arrested for breaking and entering. The parents 
attributed the behaviour of the boy to injuries to the head which he had received. 
The stealing, however, seemed to be part of a quite complicated situation which 
involved undersirable sex activities of the patient with a gang of other boys who 
indulged in stealing. The misconduct in such a case is more than an individual 
function, it is a function of a social situation. The boy, after leaving the wards of 
the hospital, kept in touch with the Out-Patient Department in order that he 
might benefit by a fuller study of his problem. 

In many of the cases referred by the court the attitude of the patient towards 
problems of the sex life is an important factor. A study of these patients furnishes 
valuable material for the understanding of the sex life in general, and this knowledge 
is of great importance for outlining the general principles which are helpful for the 
direction of the normal individual in regard to this important question. 

As can be seen from these brief notes, the psychiatrist has to be somewhat am- 
phibian, at one time he is dealing with detailed problems of the biochemistry of the 
system and with the functioning of the individual organs, at another time he is 
dealing with the organization of human nature and with the reaction of the indi- 
vidual to a social environment which is permeated with cultural values. To do 
justice to this varied material one requires the laboratory facilities and the technical 
personnel which are necessary for the investigation of the bodily functions, but one 
also needs facilities and personnel equipped for the analysis of the personality of 
the individual patients and for the study of the environmental influences to which 
he has been subject. 

Among the physical conditions which have come up for careful examination and 
treatment may be mentioned diabetes, pernicious anemia, tuberculosis, hypothy- 
roidism, arteriosclerosis, gastro-intestinal disorders and heart disease. 

With regard to the personality of the patients, the greatest variety of endowment 
is met with and the patients show a very wide range of intelligence. A study of 
the personality is much more complicated than the measuring of the intelligence 
with a standard series of tests; it includes an appreciation of the role played by the 
emotions, the instincts, the creative imagination and rational thought, and of the 
experiences through which the individual patient has gone and which have helped 
to determine his special sensitiveness and scheme of values. 

O.N Treat.me.\t in General: On the Nur.sing Service and on the Department 
OF Occupational Therapy 
It is sufficiently apparent from the brief data given above on a few patients that 
treatment in the Boston Psychopathic Hospital has to cover not only the special 
problems of abnormal behaviour and of abnormal subjective attitudes but also 
the various physical disorders which may be at the basis of the above manifestations. 
In general medicine the tendency has been to concentrate too much on the physical 
disease and to neglect the patient, while the converse fault of psychiatry may have- 
been to focus too exclusively on the more complicated functions and to neglect 
the presence of underlying somatic disorders. Treatment of the mental patient 
requires due attention to both factors, and the heart and blood, nutrition and ex- 



8 



P.D. 137 



cretion, must receive the same careful attention which they receive in a general 
hospital, while disordered activity and mood, hallucinations and delusions, present 
a further demand on the therapeutic interest of the physician. The management 
and treatment of the patient involves not only attention to the ordinary bodily 
needs, but in addition some program of activity; a tolerant and encouraging at- 
mosphere is of the greatest importance, and there must be ample opportunity for 
the patient to unburden himself of disturbing preoccupations. 

In supplying these conditions the nursing staf: and the occupational therapists 
play an important role. The large number of patients and the brief stay of many 
patients in the hospital present special difficulties, and the limited facilities of the 
occupational department make it only possible for the patients to spend a brief 
part of each day in some special craft. The work of the department is in unusually 
skilled hands, and the patient is encouraged to see his work not as an idle pastime 
but as a contribution to the needs of the social group with which he is temporarily 
associated. In the nursing force the presence of a group of affiliated nurses, who 
spend three months in this hospital as part of their general training, is now an 
established arrangement the advantages of which have been emphasized in pre- 
vious reports. 

On the Social Service Department 

The progress of medicine has extended the feeling of responsibility of the physi- 
cian in some directions. He no longer feels content to give advice with regard to 
symptoms or underlying disease on the basis merely of the data which the indi- 
vidual patient brings to him and of the observation which he himself can personally 
make. He frequently requires data from other sources besides the patient himself, 
and he knows that for the efficient carrying out of the treatment some additional 
personal service must be at the disposal of the patient. Modern medicine, there- 
fore, makes use of the ancillary service of trained workers, whose role it is to help 
the physician in his investigations and in his treatment. 

If such service is of use in general medicine, it may be said to be indispensable 
in the field of mental disorders, with the complexity of its data and its handicap 
of evil traditions. In many cases, without the data which are obtained from the 
psychiatric social worker, the physician cannot fully understand the origin of the 
symptoms with which he has to deal and their essential nature; without the same 
help he is unable to translate into actual terms in the concrete situation the general 
principles of treatment. For the readjustment of the individual to his concrete 
life situation it may be necessary not only to put the physical health of the patient 
on a sound basis, to bring some harmony into the conflicting factors of human 
nature, but also to modify the social environment and to encourage and advise the 
patient during the transition period when he is reestablishing himself in the com- 
munity. 

For this work the psychiatric social worker is specially trained. Individual 
workers have their own special interests, and any attempt to define too strictly 
the exact role of the psychiatric worker, and to make this definition binding on the 
group is probably a mistaken effort. Some workers prefer to confine their activity 
more to the investigative side of the work; others, and these apparently in the 
large majority, wish to feel that they are contributing to the treatment of the 
patient. There may be some who, in their zeal for treatment, overstep judicious 
bounds, but the physician does well to encourage this healthy therapeutic interest 
so long as it is not combined with pretentiousness or lack of insight into personal 
and professional limitations. 

In psychiatric social work, as iji the work of the psychiatrist himself, time is an 
important factor: intensive work on a patient is very time-consuming so that only 
few patients can have their cases taken up in this way. Here, too, the important 
task is to choose judiciously those cases which require intensive treatment and to 
leave a reasonable amount of time for the somewhat less intensive work which may 
be required by a very large number of the patients. 

The psychiatric social worker has the problem not only of cooperating with the 
hospital personnel in their work with the patients in the hospital, but also the task 
of cooperating with the varied agencies which refer patients to the hospital for 
study, diagnosis or treatment. Those patients who are sent by the court, by the 



P.D. 137 



9 



school, by welfare agencies, etc., are often brought merely for a single consultation 
to the Out-Patient Department. In some cases the agencies wish the patient to 
keep in touch with the Out-Patient Department, and to be under the complete 
supervision of the department. In other cases the agency wishes a report from the 
psychiatrist which will enable them to carry out more efficiently their own special 
function. The report of a psychiatrist to an agency, especially when based on a 
single interview, is apt to be of a somewhat formal nature. It may contain a specific 
statement as to the physical status of the patient, it may give a more or less precise 
indication of the level of intelligence as indicated by standard tests, but it cannot 
cover that analysis of the personality of the patient, of special trends, of the gen- 
eral mental assets and liabilities, which should be the basis for further constructive 
work. Some of this material may have come to the observation of the psychiatrist 
and be of practical importance but may not find its way into the official report to 
the agency. The psychiatric social worker is able in many cases to act as the inter- 
mediary between the psychiatrist and the agency and to make more concrete and 
more specific the report which the agency receives. 

In addition to such practical demands made upon her, the psychiatric social 
worker is faced with special problems of method and of interpretation. During the 
past year some of these problems have been made the subject of research by indi- 
vidual workers, and the results of these investigations have been submitted in the 
form of theses for the M. A. degree. 

Ox Research 

The preceding remarks have given some idea of what is included in the routine 
practical demands made on the hospital in the study and treatment of the patients 
who are admitted there. 

In dealing with these varied problems the psychiatrist, more than any other 
medical specialist, is forced to recognize that his specialty is an art rather than a 
science, and that he is dealing in an empirical and intuitive way with many prob- 
lems. He realizes the urgent necessity of careful investigation in order that his 
examination and diagnosis should be more precise and his treatment more specific. 
The problems which he meets in the wards inevitably suggest topics for special 
investigation, and it is one of the main problems of the hospital to see that this 
spirit of curiosity is utilized for productive research. 

There is an embarrassing choice of problems at which to work. The special piece 
of work chosen by the individual physician depends partly upon the problems 
which are brought by the patients and partly upon his own temperamental interests 
and previous training. One physician may be more interested in the intimate 
mechanisms of the biochemical changes or of the structural damage which are at 
the basis of conditions of mental confusion; another may be more interested in 
the more complex determinants of human personality, in the evolution of the sex 
instinct and the way in which it moulds the whole personality. A third may be 
more interested in the question of psychological types. Other workers again may 
be interested in the social factors which mould the life of the individual, in the 
cultural factors which determine his beliefs, in the environmental influences of 
home, school, playground and workshop. 

The reports from the special departments give some idea of the lines along which 
various workers are carrying on special investigations. Dr. Grabfield, in charge of 
the laboratory of internal medicine, where investigations are made on the general 
chemical changes in mental disorders, refers to one or two special topics of investi- 
gation in this field. 

Mrs. Sanborn has finished the report of her painstaking studies on the bac- 
teriological flora of the intestinal tract, and two communications embodying her 
results are in press and will shortly appear. 

Dr. Solomon gives in some detail an account of the reaction of stuporous patients 
to the administration of carbon dioxide. With the cooperation of several workers 
he is investigating in detail the factors involved in this reaction. He also refers to 
special pieces of work in regard to the treatment of epilepsy and of neurosyphilis 
and calls attention to the fact that important investigative work is sometimes 
seriously handicapped by lack of financial support. 

The systematic work which is being carried on in the psychological laboratory is 



10 



P.D. 137 



presented in a very concise way by Dr. Wells, but the brevity of this report should i 
not obscure its importance; the painstaking and consistent work which is being; 
done in the field of mental tests is not only of value to the hospital but makes an 
important contribution to all those interested in the field of clinical psychology. 

It is many years since the hospital has had in charge of the neuropathological 
laboratory a physician whose whole time was available for the post mortem study 
of cases who died at the hospital, and for detailed investigation of the anatomical 
changes associated with the various forms of mental disorder. Dr. Fulstow, the 
state pathologist, is acting chief of the neuropathological laboratory, but her state 
duties make heavy demands upon her time so that the want; of intensive research 
into the anatomical basis of mental disorders makes the scientific work of the 
hospital not so well balanced as it ought to be. It is hoped that it will be possible 
to return to the situation in 1920 when the pathologist of the hospital was able to 
give her full time to this special line of research. 

Special attention has been given during the past year, as during previous years, 
to clinical research on schizophrenia, a disorder or group of disorders with a rather 
serious outlook and where the underlying causes are complex and subtle. The 
patients with this type of disorder are the patients who tend to accumulate in the 
large state hospitals and form the large bulk of the chronic population of the latter. 

With funds allotted by the Laura Spelman Rockefeller Foundation a special 
personnel has been available for carrying on research work on this group of cases 
during the past few years. It is hoped to delimit this group a little more clearly, to 
make more precise the different types of disorder which are grouped under the term 
schizophrenia, to study the development of individual cases in a more intensive 
way, to estimate more accurately the respective importance of constitutional 
vulnerability, of environmental stresses and strains, of bodily weaknesses in the 
development of the disorder. The broad issue is to determine how far this mental 
disorder is to be looked upon as the indication of some underlying physical dis- 
turbance and how far it is to be looked upon as the reaction of certain peculairly 
vulnerable individuals to the stresses and strains of their own particular environ- 
ment. Much preliminary work must be done before one can think in terms of a 
rational treatment or of prevention. 

At the present moment it is premature to discuss schizophrenia as if it represented 
one uniform process; it is quite possible that under this term may be included a 
large number of groups which have very little kinship among themselves. It is 
necessary to give some precision to each of these groups, and then to analyze in 
detail the causative factors in each group. With the help of the research personnel 
working under the special appropriation referred to, a statistical attack on this 
problem has now been carried on for some time. 

A problem of this nature takes one beyond the analysis of the individual patient 
into the social environment. The invididual cannot be adequately studied as an 
independent unit but has to be understood as developing in a community with 
certain modes of belief and certain standards of value, brought up in a family 
atmosphere which seriously moulds the whole personality, and subjected to im- 
portant influences in the schoolroom, the playground and the general social and 
working environment. It is absolutely futile in many cases to attempt to under- 
stand the behaviour and the beliefs of the patient if one does not take into account 
the wider circumstances of his life. To get an accurate picture of these circum- 
stances and to reduce the complexity of environmental influences to a series of 
precise data is a difficult task. The nature of these difficulties has been made a 
special subject of investigation to which reference is made in the report from the 
social service department. Research of this nature into the personal and social 
background of patients, while taking its start from the problems of a special group 
of patients in a psychopathic hospital, deals with very fundamental human and 
social problems and is of considerable importance to those working in education 
and in the social sciences. 

On the Out-Patient Departmea't 
The work of the Out-Patient Department has continued to play the same im- 
portant part in the total work of the hospital as in previous years. It has served to 
a certain extent as an admitting service to the hospital, but to a much larger extent 



P.D. 137 



11 



it has been a centre of consultation and treatment for a great variety of patients 
who are not admitted to the hospital. These patients may have come of their 
own accord or are brought by some member of the family. They may still be 
carrying on their ordinary vocation, either in school or in industry. 

Many patients do not come because of symptoms which disturb them or because 
their relatives realize that they are sick, but are brought on account of some special 
situation. Thus children are referred by the school system in order that the teacher 
may deal with certain school problems with fuller data and insight than her own 
professional qualifications allow. Patients are referred in increasing numbers by 
the courts as it is increasingly recognized that delinquent behaviour in many cases 
can be intelligently dealt with only in the light of a psychiatric review. Patients, 
both children and adults, are referred by the greatest variety of welfare agencies in 
order that these agencies may deal more satisfactorily with their own special prob- 
lems. Each agency has its own type of material, its own special function, its own 
personnel, and may demand from the Out-Patient Department a type of service 
which is somewhat different from that demanded by another agency. One agency 
may send a child for the sole purpose of having an intelligence test made; another 
agency sends a somewhat similar case in order that a complete diagnosis may be 
made; a third agency may refer the patient not only for diagnosis but also for 
treatment, and expect the hospital to assume complete supervision of the case. 

The conditions of work in an out-patient department are of necessity different 
from those in regard to the patients in the wards of the hospital. The out-patient 
study of a case can seldom be expected to have the same completeness as the study 
of a patient who remains under observation in the wards for a period of several 
days or even weeks. To make an intelligence test requires a certain time, the 
limitations of which are not difficult to determine. To get into touch with a child 
so that the child reveals frankly his feelings, his experiences, his attitudes, involves 
an amount of time which is extremely variable and not easy to foretell in the in- 
dividual case. It is a great advantage when the agency has already made a thorough 
and systematic review of the environmental factors and brings to the Out-Patient 
Department a well arranged record. Where only meagre information as to the 
social background is available, and the opinion of the psychiatrist has to be based 
almost altogether on the observation made during the out-patient department inter- 
view, the report of the psychiatrist is often guarded and incomplete, and the agency 
may be at times impatient that so little help has been given on the individual case. 

For the best utilization of the facilities of the clinic mutual understanding by 
the hospital and by the agencies of their respective spheres of work and their re- 
spective limitations is important. A cooperative attitude should lead to a deeper 
appreciation by the hospital personnel of the mental health needs of the community 
and of the facilities available in this field, and on the other hand to a growing sensi- 
tiveness of welfare workers to the mental health aspect of their special welfare tasks 
and to the type of help which they can reasonably expect to get from the psy- 
chiatrist and his associates. 

In conclusion I wish to express my appreciation of the spirit of good-will, loyalty, 
and earnest endeavor shown by the staff and other workers at the hospital. The 
thanks of the staff are especially due to the consulting physicians who respond with 
so much generosity to the frequent calls made upon them by the resident staff. 
The Chief Executive Officer has an extremely complicated task to fulfill, and his 
eflficient and tactful response to the numerous and ever varying demands that are 
made upon his resources gives the clinical staff the opportunity to carry on their 
work on the wards in an uninterrupted manner. 

The thanks of the Director are especially due to the members of the Board of 
Trustees who have during the past year, as in previous years, been very assiduous 
in their attendance at Board meetings and have taken every opportunity of offering 
helpful and constructive advice, and to Dr. Kline, Commissioner of Mental Diseases, 
who has always been available for consultation and advice and has continued to 
give his support to any measure which promised to maintain or improve the stan- 
dards of work at the hospital. 

Respectfully submitted, 

C. MACFIE CAMPBELL, 

Medical Director. 



12 



P.D. 137 



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P.D. 137 



REPORT OF THE OUT-PATIENT DEPARTMENT 

To the Medical Director of the Boston Psychopathic Hospital: 

I herewith submit the report of the activities of the Out-Patient Department for 
the year ending November 30, 1930. | 
The staff of the clinic during the past year was as follows: i 
Dr. C. Macfie Campbell, Director of the Hospital. 
Dr. Oscar J. Raeder, Chief of Out-Patient Department. 
Dr. Mary Palmer, Assistant Physician. 

Dr. Charles B. Sullivan, Assistant Physician, part time. j 

A member of the house staff daily. 

Miss Villa T. West, Clinic Manager to August 1. 

Miss Annie C. Porter, Clinic Manager from October 13. 

Special Workers: Dr. Marianna Taylor; Dr. Jessie D. Campbell; Dr. Charles 
H. Sanford, May 1, 1930, to July 1, 1930; Dr. Donald R. Fletcher. 

Students: James E. McLester, May 1930; Charles H. Shedd, October 15 to I 
November 15, 1930. 

The work consists of the following: 

(a) The study and treatment of nervous and mental diseases, including conduct 
disorders of children. { 

(b) Examination of retarded children of the Brookline public sctiools. ' 

(c) Teaching of students and nurses. 

During the year 1,109 new cases were studied and treated. Of these 68 were • 
examined in the syphilis division; of the others 439 were adults, 222 adolescents, 
and 380 children. | 

Among the adult patients treated, the psychoneuroses formed the largest group, j 
99 cases. The large majority of these were treated and followed by the clinic and ' 
this represents a considerable proportion of the work on account of the time neces- 
sarily consumed in the tedious and painstaking exploration of the mind. ( 

Psychoses were next in point of frequency, the manic-depressive 48, the schizo- 
phrenic 32, paranoid 8 and other psychoses 28. Among these was a small group of , 
senile psychoses, which were mostly referred to other state hospitals for treatment, i 
Feeblemindedness was not uncommon among the adults. | 

Among the children feeblemindedness was the most common diagnosis made. i| 
Many of the conduct disorders, such as truancy, stealing, etc. were based on feeble- I 
mindedness. \ 

Many of the children who scored low on psychometric tests were found to be j 
reading problems, i.e., the psychometric rating was not representative due to a ; 
special defect in reading ability. This is one of the most difficult problems to treat ■ 
inasmuch as these children do not fit in well in the school with the special class 
group and it is difficult to supply the special instruction in reading required by 
them. They do not learn to read by the ordinary methods of teaching reading. 
There were 23 cases of reading difficulty. 

An important part of the work of the clinic is that in connection with cases i 
referred by the juvenile courts for diagnosis and advice. These cases are mostly 
brought by social agencies and often given follow-up treatment in the clinic. 

Another considerable group consists of cases referred directly by the schools. 
Many cases of conduct disorder without defective intelligence swell this group. 

The problems of the feebleminded adolescents are important from the point of 
view of social economics and public health, i.e., on account of illegitimate preg- 
nancies and the spread of venereal disease. It is in this group that sex is the greatest ; 
problem. 

The problems of the neurotic child include conditions such as enuresis, temper 
tantrums, running away and vagrancy, many of which too often find their cause in 
the ignorance of the parents or in parental neglect and other social problems of the ' 
family. The clash between old world customs and American codes is a frequent 
factor in the troubles of children of foreign born parents. 

The school survey of the Brookline schools was conducted by Dr. Mary Palmer ] 
with the aid of the psychologist, the social worker and the school nurse. The 
figures of this report are given herewith: 



P.D. 137 



19 



School Survey of Brookline Schools 1929-1930 
School Clinic Staff: Dr. Mary Palmer, Psychiatrist, Mrs. Gertrude Pierce, 
Teacher; Mrs. Helen C. Bowie, Psychologist, Miss Ethel A. Gleason, Social Worker. 



Names of Schools and Number of Students Referred 

Baldwin 4 Parsons 3 

Devotion 4 Pierce 8 

Driscoll 10 Winthrop 4 

Heath 27 Runkle 28 

Lawrence 4 Sewall 8 

Lincoln 30 

Total 130 

Pupils in Survey first time: 

Boys 46 Girls 28 

Pupils in previous Survey: 

Boys 39 Girls 17 

Summary of results from the point of view of the Intelligence Quotient: 

I. Q. .69 or below I. Q. 70-80 I. Q. 80-90 

Boys Girls Boys Girls Boys Girls 

4 2 18 5 13 15 

L Q. 90-110 I. Q. 110 or above 

Boys Girls Boys Girls 

40 20 10 3 



Of the new cases studied it was recommended that 11, of whom 6 were boys and 
5 girls, should be placed in a special class. Of the old cases seen again it was felt 
that 9, 8 boys and 1 girl, should be in a special class. It was recommended that 1 
boy should have institutional care. 

On the basis of chronological age, using 6H years in first grade as a standard: 
44 students were 2 years retarded. 
21 students were 3 years retarded. 

1 student was 4 years retarded. 
Group showing retardation of 2 years: 

5 students had an I. Q. of 70-80. 
12 students had an I. Q. of 80-90. 
23 students had an I. Q. of 90-110. 

4 students had an I. Q. of 110 or above. 
Group showing retardation of 3 years: 

4 students had an I. Q. of 70-80. 

5 students had an I. Q. of 80-90. 
10 students had an I. Q. of 90-110. 

2 students had an I. Q. of 110 or above. 
Group showing retardation of 4 years: 

1 student had an I. Q. of .75. 

The following tables are self-explanatory and indicate further the nature and 
scope of the clinic activities. 

Statistics of the Out-Patient Department 
October 1, 1929, to September 30, 1930. 

Total New Cases 1,109 

Out-Patient Department 1,041 



Syphilis Division 






68 


New Patients: 


Male 


Female 


Total 


Adults 


. 223 


216 


439 


Adolescents 


76 


146 


222 



20 



P.D. 137 



Children 


. 204 


176 


380 




OUo 


OOO 


1 f\A 1 

1,U41 


Plus: 








Syphilis Patients 


. 25 


43 


68 




528 


581 


1,109 



Nationality 





M. 


F. 


T. 




M 


F. 


F. 


African 


10 


20 


30 


Italian . 


. 52 


46 


98 


Albanian . 


3 


1 


4 


Lithuanian . 


. 1 


7 


8 


Armenian 


3 


3 


6 


Masrvar 


3 





3 


Bulgarian . 


1 





1 


Portuguese . 


. 5 


6 


11 


^ninese 




n 
U 


9 


Scandinavian (not 








uutcn 


1 


1 


o 


specified) . 


. 14 


lo 


27 


English 


109 


132 


O /I 1 


Scotch . 


1 Q 


1 Q 

lo 


O ( 


Finnish 





2 




Slavonic 


1 o 




O 1 


French 


14 


30 


y< A 
44 


Spanish 


1 





1 


German 


5 


12 


1 1 


Syrian . 


1 


Q 
O 


Q 

y 


LrreeK 


8 


2 


10 


Mixed 




1 o 

18 


40 


Hebrew 


69 


48 


117 


Race unascertained 


. 61 


69 


130 


Indian (American) . 


1 





1 










insn .... 


86 


93 


1 < y 


1 otal . 


. OUo 


coo 


A f\ A 1 

1041 








Re j erred by 


















M. 


F. 




T. 


Boston Psychopathic 


Hospital . 




. 15 


15 




30 


Other hospitals 








. 90 


97 




187 


Local physicians . 








. 71 


46 




117 


Social Agencies . 








. 175 


270 




445 


Schools . 








. 33 


20 




53 


Court 








. 32 


10 




42 


Relatives and friends 








. 69 


58 




127 


Police . 








1 


2 




3 


Own initiative 








. 17 


20 




37 



503 538 1,041 

Problems 

a. Behavior problems: 

Seclusiveness, sex delinquency, misconduct, larceny, litigiousness. 
6. School problems: 

Intelligence rating, reading difficulty, retardation, speech defect, truancy. 

c. Personality problems: 

Lack of ambition, lack of concentration, inability to hold positions, inability ,to 
work. 

d. Domestic problems: 

Sexual maladjustments, advisability of sterilization, incompatibility. 

e. Nervousness: 

Shaking, fears, timidity, numb feeling, worries, insomnia, depression, hysteria, 
enuresis, delusions, hallucinations, eating difficulty, sleeping difficulty, stammering, 
listlessness, day dreaming, night terrors, twitching, excitability, somnabulism, 
mood swings, over-religiousness, epilepsy, convulsions, amnesia, muscular atrophy, 
chorea, irritability, alcoholism. 

/. Routine examinations (for adoption, etc.) 
g. Vocational guidance. 



P.D. 137 






21 


Diagnosis 








Psychoses: 


Male 


Female 


Total 


Manic depressive 


. 26 


22 


48 


Schizophrenic 


. 18 


14 


32 


Paranoid 


1 


7 


8 


Arteriosclerotic 





1 


1 


Neurosyphilic; paretic 


6 


1 


7 


Alcoholic 


2 





2 


Epileptic 


1 





1 


With other brain or nervous diseases . 


4 


2 


'6 


With somatic disease 





1 


1 


With feeblemindedness 


1 


1 


2 


Due to exogenous toxins (drugs) .... 


1 





1 


Post-puerperal (mild) 





1 


1 


Unclassified 


1 


5 


6 


Psychoneuroses 


. 55 


44 


99 


Psychopathic personality 


. 10 


8 


18 


Constitutional psychopathic inferiority . 


2 


4 


6 


Neurotic child 


. 13 


19 


32 


Epilepsy 


6 


7 


13 


Chorea 


1 


2 


3 


Parkinson's disease 





1 


1 


Post-encephalitic syndrome 


1 





1 


Chronic alcoholism 


1 


1 


2 


Organic brain and nervous disease .... 


4 


2 


6 


Multiple sclerosis 


1 





1 


Arteriosclerosis 


3 





3 


Malingerer 


1 





1 


Abnormal environment 


5 


8 


13 


Without psychosis 


2 


1 


3 


Intelligence ratings: 








Superior intelligence 


. 21 


22 


43 


Average intelligence 


. 59 


72 


131 


Borderline intelligence 


. 92 


134 


226 


Feeblemindedness 


. 53 


70 


123 


Mongolian idiocy 





2 


2 


Cretinism 





2 


2 


Microsomia 





1 


1 


Hydrocephalus 





1 


1 


Reading defect 


. 16 


12 


28 


Stammering 


2 





2 


Uncertain diagnosis: 








Personality problems 


. 8 


1 


9 


Behavior problems 


. 34 


24 


58 


Traumatic 


2 





2 


Endocrine disorder 


1 





1 


Chorea 


1 


1 


2 


Early psychosis 





2 


2 


Beginning progressive muscular atrophy 


1 





I 


Rickets 





1 


I 


Diabetes 





1 


I 


Alcoholic residual 


1 





I 


Chronic invalidism 


1 





1 


Deferred 


45 


40 


85 




503 


538 


1,041 



22 



P.D. 137 



Disposition 





Male 


Female 


Total 


Treatment in Out-Patient Department . 


. 276 


218 


494 


Admitted to Boston Psychopathic Hospital . 


. 34 


37 


71 


Institution for F. M. advised 


8 


8 


16 


State Hospital advised 


11 


7 


18 


Referred to General Hospital 


3 


4 


7 


Report to court 


. 28 


9 


37 


Report to school 


4 


2 


6 


Report to social agency 


. 138 


251 


389 


Institution (Lancaster) advised .... 





1 


1 


Return to work advised 


1 





1 


Referred to habit clinic ...... 


A 
U 


1 


1 








1 A/! 1 


Visits 








Total visits 






2,493 


Visits of new patients 




1, 


794 


Out-Patient Department 




1,726 




Syphilis Clinic 




68 




Visits of old patients 






699 


Clinic days 






. 303 


Average attendance per day 






8 



Visits per Year 

New Patients: 

Number of patients Number of visits Total visits 

718 1 718 

185 2 370 

59 3 177 

43 4 172 

11 5 55 

2 6 12 

7 7 49 

5 8 40 

4 9 36 

4 12 48 

1 15 15 

1 16 16 

1 18 18 



1,041 1,726 
Old patients: 

188 1 188 

94 2 188 

16 3 48 • 

32 4 128 

15 5 75 

12 6 72 



357 . 699 



The part played by the psychological department is of the utmost importance, 
not only in the measurement of intelligence in cases of feeblemindedness and others, 
but also in discovering other abnormalities such as reading disabilities, and giving 
advice for their correction. 

Much of the success of the clinic is due to the cooperation of the Social Service 
Department. A great amount of time is required for follow-up treatment of cases 
as well as for investigating and gathering data often necessary for diagnosis and 
treatment by the psychiatrist. 



P.D. 137 



23 



The teaching of psychiatry to students of medicine and affiliating nurses has 
been carried on as before. 

Clinical staff meetings were held twice weekly for the discussion of problems, 
and these meetings, presided over by the Director, have been important and 
valuable to patient and student alike. 

Bi-weekly executive staff meetings, in which each case is considered, have been 
valuable to psychiatrist, psychologist and social workers in furnishing a forum for 
interplay and development of ideas very beneficial to the daily work of the clinic. 

The daily contact, consultation, and the whole-hearted cooperation of the staff, 
of all the physicians, psychologists and social workers has been not only a very 
important factor in the success of the clinic but also the basis of a delightful esprit 
de corps and a wholesome atmosphere in which to work. 

Respectfully submitted, 

OSCAR J. RAEDER, 

Chief of Out- Patient Dept. 

REPORT OF THE CHIEF MEDICAL OFFICER 
To the Medical Director of the Boston Psychopathic Hospital: 
I herewith submit the medical report for the year. 

There have been comparatively few changes in the medical service during the 
past year. There has been the usual change of personnel as the medical staff is 
composed entirely of physicians who are here for training so that many changes 
occur each year. There were more than the usual number of changes occurring 
on the first of September, 1930, and only one member of the medical staff remained 
on for the coming year. This raises the question as to whether it would be better 
to have some appointments occurring at some other time of the year, for example 
March 1st, in order that there should not be such a great change in the medical 
staff at one time. 

In last year's report, it was noted that there had been a marked increase in the 
number of physically sick patients admitted to this hospital. This condition has 
continued throughout the present year and has tended to complicated matters at 
times as we have had a large number of physically sick patients in the hospital too 
sick to be transferred to other hospitals. As our bed capacity is only 100, and as 
the admission rate is about 1900 during the year, it will be seen that these cases 
form a difficult problem. It is often impossible to secure an ambulance to transfer 
them to another hospital, and at times the hospital has had to keep such patients 
for a period of several months. If patients are admitted with acute, curable physi- 
cal disorders, it is quite suitable for them to remain in the Boston Psychopathic 
Hospital, which is especially equipped for dealing with them; where such cases are 
suffering from chronic disorders they limit the number of other patients who can 
be kept on at the hospital, with no particular benefit to the chronic cases, which 
ultimately have to be transferred to some other state hospital. 

During ihe year there have been a number of interesting physical and neuro- 
logical cases, presenting such conditions as brain tumor, pernicious anemia, pellagra 
and many of the more common medical conditions such as diabetes, pneumonia 
and kidney conditions. 

Ward A has again been utilized for cases of general paresis and has been open 
continuously through the year. 

Ward B has been open for part of the time, and further work on the reaction of 
j stuporous patients to carbon dioxide and sodium amytol has been carried out. 

Through a special appropriation, we have secured equipment for diathermy, 
[ ultra-violet and infra-red therapy. Arrangements have been made for the x-ray 
I technician, Mrs. Morgan, to secure special training in the use of the equipment and 
through the kindness of Dr. Bryan, Superintendent of the Worcester State Hospital, 
she has spent time at that hospital receiving instructions. This new equipment 
will be put into use this coming year. 

In addition to the regular staff of the hospital, five Commonwealth Fund Fellows 
in Fsyhchiatry are working at the hospital. The presence oi these men, four of 
whom have completed internships at this hospital, is very helpful. 



24 



P.D. 137 



Dr. Kaufman has recently returned from a year's study in Vienna and is doing 
some intensive work in psychoanalysis with certain cases with psychoses. 

Dr. Scott is making a special study of depressions, with special attention to the 
gastric function. 

Dr. d'Elseaux is assisting Dr. Solomon in a study of stuporous cases, making 
careful biochemical studies. 

Dr. Coon is assisting Dr. Campbell in a clinical study of the schizophrenic con- 
ditions. 

Dr. Saul is working partly in the clinical field, partly in the physiological lab- 
oratory. 

The special research on schizophrenia, financed by the Laura Spelman Rocke- 
feller Foundation, has continued throughout the year. 

In this research two psychiatrists, a statistician, four social workers and a sten- 
ographer have been utilized in securing more extensive and accurate data concerning 
selected cases of schizophrenia, and control cases of general paresis and manic- 
depressive psychoses. 

This research is another example of how the hospital is attracting around it a 
large number of special workers. This results in more intensive study of the indi- 
vidual patients and in the accumulation of important scientific data. Such work 
is of great advantage to the hospital and to the State, but it also imposes further 
responsibility on the staff and complicates still further the routine of a busy 
hospital. 

At the present time, with research workers supported by private funds, and a 
number of physicians coming, not only from the United States, but from other 
countries, for training, it seems worth while pointing out that the physical equip- 
ment of the hospital has changed very little since the hospital was built. 

If an addition could be built to the hospital with special research wards and 
added equipment, further progress could be made in attacking some of the funda- 
mental problems of mental disease. 

At the present time, with a bed capacity of 100, and an admission rate of 1,900, 
it is not possible to keep as many cases for intensive study and treatment as is 
desirable. The hospital is often over-crowded and because of the great fluctuation 
in the admission rate, a number of beds must always be available for new admissions. 
With additional beds for research, this problem would be much less acute. 



The report of Dr. Dalton, the resident dentist, fol 
Patients examined . 
Patients receiving treatment 
Extractions 
Fillings 
Prophylaxis 
Plates 

Other treatments 



ows 



1,656 
974 

1,035 
455 
256 
3 

221 



X-ray studies of 66 cases showed infection in 24, doubtful infection in 15, nega-f 
tive in 23, impacted teeth in 4. 

The X-ray report for the year is given below: 



Number of patients X-rayed 



December 1929 
January 1930 
February 1930 
March 1930 
April 1930 
May 1930 
June 1930 
July 1930 
August 1930 
September 1930 
October 1930 



Male 


Female 


Total! 


. 33 


40 


73 ; 


. 35 


23 


58 i 


. 36 


29 • 


65 


. 40 


38 


78 \ 


. 30 


40 


70 '. 


. 24 


29 


53 i 


. 19 


33 


52 i 


. 34 


23 


57 1 


. 34 


21 


55 ' 


. 30 


13 


43 ! 


. 32 


34 


66 i 



P.D. 137 






25 


November 1930 . 




. 39 19 


58 






386 342 


728 




Anatomy 






1 o tai 




Total 


Gastro-intestinal series . 


Q7 
o t 


Jvnees .... 


. 12 


Teeth .... 


A O 


Mastoid .... 


4 


Skull .... 


.248 


Elbows .... 


. 12 


Chest .... 


.230 


Shoulders 


. '8 


Ribs 


Q 
O 


Coccyx .... 


Q 

o 


Pelvis .... 


. 9 


Hips .... 


9 


Spine .... 


. 23 


Graham gall-bladder 





Sinuses .... 


. 28 


Kindeys .... 


. 15 


Feet .... 


. 39 


Barium enema 


6 


Hands .... 


. 31 


Pneumograph 


. 9 


Total 






TOO 

.788 



In many cases of mental disease, a satisfactory history cannot be obtained, the 
patient is not cooperative, and even physical examination may be difficult. Cases 
of brain tumor, brain abscess, fracture of the skull, pneumonia or other chest 
condition may be brought into the hospital with no information to aid in the diag- 
nosis. For this reason a much larger number of x-ray examinations are made than 
would be required if fuller data were available in all cases. 

In spite of the increased appropriation for medical supplies, it has again been 
difficult to keep within the budget. The increased use of the x-ray, which should 
be encouraged, means that still further money is necessary if one is to utilize this 
department to the fullest extent. 

Respectfully submitted, 

KARL M. BOWMAN, 

Chief Medical Officer. 

REPORT OF BIOCHEMICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

This year has brought forth no particular changes in the personnel or admin- 
istration of the laboratory, but this report is sufficiently near to the end of the first 
decade of the laboratory, under the present administration, for it to seem desirable 
to cast up certain accounts and, perhaps, suggest improvements or changes. 

The first question that comes to mind is the exact function of the "bio-chemical" 
laboratory. This is somewhat of a misnomer as it serves to include most of the 
medical laboratory activities of the hospital. It appears to us that the functions 
may be divided into three parts: first, the provision of clinical laboratory service 
for the wards; second, the pursuit of independent laboratory research; and, third, 
the collaboration with the clinical staff in research into the pathological physiology 
of patients with mental disease. 

These three functions have all been represented in the work of the last decade. 
The first may be dismissed by the comment that we have elected to have a student- 
interne system, in which medical students serve as part-time internes doing the 
ordinary clinical laboratory work for the wards. While this system has its dis- 
advantages in that the students are present at the hospital only in their "off" 
hours, it has the virtue of economy, and of training of students and the work is, in 
some respects, better done than it would be by a technician. A full discussion of 
this question will be found in previous reports. 

As to the function of the laboratory in the prosecution of research, this necessarily 
depends upon the interest of the personnel. If the chief of the Laboratory is not a 
psychiatrist, the hospital materfal provides normal controls for his work on disease, 
or normal material for purely physiological or pharmacological experiments. Of 
course, if the junior chemist chooses to do research in pure chemistry, that also 
can be prosecuted. Under the present regime, the chief of the Laboratory has 



26 



P.D. 137 



also been Consultant in Medicine, and the work done here has been of the character 
indicated and having only a remote relation to psychiatry. 

From the beginning, however, the third function has had considerable attention. 
The Chief of Staff has been very active in devising laboratory experiments on psy- 
chiatric patients, and certain other members of the staff have also done similar 
work. A reference to previous reports will demonstrate this point. It is my belief 
that this part of the work is the most important for the hospital, and the Director 
has constantly emphasized this to the staff. This year, Dr. Scott, a Commonwealth 
Fund fellow, is working on the hydrogenion content of the gastric juice of patients 
with functional gastric symptoms. 

This whole discussion bri^gs up the problem of the future orientation of the 
laboratory. It seems to me that if the Consultant in Medicine and Chief of the 
Laboratory be combined in the same individual, the laboratory will continue to be 
a somewhat separate unit from the general service of the hospital, and this is, 
perhaps, the most important criticism of the present regime. On the other hand, 
if the laboratory is headed by what one might call an experimental psychiatrist, 
the laboratory becomes divorced from the medical consultant service, which is also 
somewhat undesirable. A third possibility of heading the laboratory by a pure 
bio-chemist might tend to increase the separation, before-mentioned, between the 
laboratory as a service, and the other services of the hospital, and would also be 
open to the objection of the second alternative. 

In the earlier part of the last decade, the Consultant in Medicine was not at- 
tached to the laboratory service and so we have had an opportunity of trying a 
divorce between these two functions, and it is my impression that the objections 
mentioned above were borne out by that. On the other hand, there is always the 
chance that it might be possible to stimulate the interest of the man in charge in 
psychiatric problems. If this could be accomplished without loss of touch with 
the non-psychiatric field of Internal Medicine, it would be ideal. 

At the present time, in addition to the researches mentioned above which Dr. 
Scott is prosecuting, we are studying the effect of gelatin diets on the nitrogenous 
constituents of the blood. Gelatin is a particularly interesting protein, in that it 
is the only edible protein which does not contain sulphur and is, furthermore, 
lacking in the amino acids which give rise to toxic pressor amines in the body. In 
addition. Dr. d'Elseaux is prosecuting investigations into the acid-base balance 
and blood gasses of patients treated by inhalations of carbon dioxide and this will 
be reported more fully by the Department of Therapeutic Research. 

We regret very much the retirement of Mrs. Emily Kubik, junior chemist, during 
the past year. She has been succeeded by Miss Ann G. Campbell. The staff of 
student internes for the past year has been Messrs. George Salter, George S. Krinsky 
Ernest Joy and Jacques Roseman. 

Respectfully submitted, 

G. PHILIP GRABFIELD, 
Chief of Biochemical Laboratory 

REPORT OF THE PSYCHOLOGICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

There has been during the past year no special change in the routine techniques 
of the Laboratory. The Kuhlmann-Anderson test introduced last year has been 
increasingly useful, the Laboratory having been fortunate in the presence on its 
staff during the summer of one of its authors, Dr. Rose G. Anderson. Planograph 
forms have done much to increase the efficiency of the routine testing. WorK 
continues with the Rorschach test which, while very difficult to use properly, is 
gaining recognition as a technique of peculiar significance where objective methods 
are at their weakest. A long planned undertaking, revision of the Army Alpha 
test, has been actively prosecuted and thanks to the effective cooperation of the 
Laboratory personnel > and of the printing department at Gardner, is now within 
sight of successful completion. 

Teaching policies continue in general as before, except that projects have be- 
come somewhat more organized and the work of students is accordingly more 
closely assigned and directed. Among the staff, Mr. Beck continues to specialize 



P.D. 137 



27 



upon the Rorschach test; Miss Ragsdale is undertaking supervision of work on 
the new Alpha; and Miss Jones has special interest in the study of the pre-school 
child. 

The problem of publications has not moved nearer a solution but its solution has 
become less pressing. Publication has ceased to occupy so essential a role in the 
diffusion of information about one's work. Its place is being assumed by relatively 
selected conferences and their reports. The writer has participated in various gath- 
erings of this nature, presenting a report on "Quantitative Methods of Personality 
Study" at Washington, under the auspices of the National Research Council, 
presiding at a session of the International Congress on Mental Hygiene at Wash- 
ington, and presenting a report on The Improvement of Psychometric Technique" 
under the auspices of the Brush Foundation at Cleveland. It is probable that this 
medium of diffusion will increase in importance relative to publication, A few of 
the studies contemplated in last year's report have been published and others will 
issue as circumstances permit. 

The Laboratory was directly responsible for the psychological portion of the 
exhibit of the Department of Mental Diseases at the Tercentenary Exhibition of 
Governmental Activities. A grateful acknowledgement is made to the various 
laboratories of other institutions which contributed exhibits, and particularly to 
the laboratory of the Worcester State Hospital which assumed the major respon- 
sibility for the supervising personnel. 

So far as practicable, effort is made to keep in touch with the activities of the 
other institution laboratories; there are several of these where work of not a little 
mutual interest is being carried on and much might be hoped for from a more 
effective interchange of ideas and practices than exists. There has been the usual 
cooperation in the matter of personnel selection. 

The Laboratory continues its cooperation in Psychological Abstracts, the 
Psychological Index, and the Child Development Abstracts. Official relations to 
the Divicsion of Psychology and Anthropology of the National Research Council 
the Psyhological Corporation, and the National Institute of Psychology, continue, 
substantially as heretofore. Some committee work is being carried on for the 
Social Science Research Council. 

As to changes in the Laboratory staff, Mr. S. J. Beck continues as psychologist. 
Mrs. E. C. Whitman resigned as psychometrist on June 1, 1930, being succeeded 
for a period of three months by Dr. Rose G. Anderson. On September 1, 1930, 
Dr. Anderson resigned as psychometrist and Miss Albertine Ragsdale was ap- 
pointed in her place. Mrs. Helen C. Bowie resigned as psychometrist on September 
15, 1930, her position being assumed by Miss Viola Jones on that date. 

Publications have been as follows: 
Beck, S. J. "The Rorschach Test and Personality Diagnosis. I. The Feeble, 
minded." American Journal of Psychiatry, Vol. 10, No. 1, July, 1930 
19-52. 

Wklls, F. L. "Guidance of Normal Adolescents." Monthly Bulletin of the 
Massachusetts Society for Mental Hygiene, Vol. 8, No. 3, December, 
1929. 

Wells, F. L. " New Problems in Psychometrics." Reprinted from the Proceedingr 
of the Fifty-fourth Annual Session of the American Association fos 
the Study of the Feebleminded held at Washington, D. C, May 5-7, 
1930. 

W^LLs, F. L. "A Short-Answer Examination in Psychiatry." Journal of Genetic 

Psychology, Vol. 37, June, 1930, 309-314. 
Well<, F. L. "Effects of Instruction on Test Performance." Journal of Genetic 

Psychology, Vol. 37, June, 1930, 314-317. 
Wells, F. L. " Comparative Reliability in Tests of a Motor Aptitude." Journal 

of Genetic Psychology, Vol. 37, June, 1930, 318-331. 

Respectfully submitted, 

F. L. WELLS, 

Head Psychologist. 



28 



P.D. 137 



REPORT OF NEUROPATHOLOGICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

During the fiscal year ending November 30, 1930, the Assistant Pathologist to 
the Department of Mental Diseases has continued as Pathologist to the Hospital 
though the major portion of her time is taken up with the work of the Department, 
namely, the investigation of sudden deaths in the state hospitals of Massachusetts. 

Thirty deaths have occurred in the Hospital in the past year. Sixteen of them 
have come to autopsy, making a percentage of 53. This is considerably larger than 
the percentage for several years previous and compares favorably with that of 
other hospitals. 

Death was due in four cases to new growths — three of them brain tumors. In 
one of these the patient died five hours after admission from a hemorrhage in a 
glioma. This case was presented at a staff conference. Seven deaths were due to 
acute infections. There were two cases of tuberculosis, two of arteriosclerosis and 
one of hemorrhage from a duodenal ulcer. 

Dr. J. M. Thomas, a former member of the staff, spent considerable time in the 
Laboratory learning histological technique as a foundation for work in neuro- 
pathology in Germany. A handicapped young woman was given at the request of 
one of the staff physicians about six months training in technique. 

Dr. J. Kasanin has been given the use of a desk in the Pathologist's office because 
of lack of space in the other parts of the hospital. 

The Laboratory cooperates as heretofore with the clinical staff of the hospital 
furnishing specimens for use in lectures to nurses. 

There has been no Assistant Pathologist since the departure of Dr. M. E. Morse 
October 17, 1926. 

The bacteriological interne, Aage E. Neilsen, reports the following work done 
for the hospital during the past year: Blood cultures, 26; spinal fluid cultures, 4; 
stool cultures, 1; miscellaneous cultures, 55; Widal tests, 4; throat smears for 
Vincents, 29; miscellaneous smears, 16. 

Respectfully submitted, 

MARJORIE FULSTOW, 
Pathologist, Department of Mental Diseases. 

REPORT OF THE DEPARTMENT OF THERAPEUTIC RESEARCH 
To the Medical Director of the Boston Psychopathic Hospital: 

The study of the effects of the inhalation of high percentages of carbon dioxide 
and of the effects of anesthesia produced by barbituric acid derivatives, has been 
continued. This work has been commented on in a report of the preceding year. 
This year, in order to go further in this study, a bio-chemical laboratory has been 
thoroughly equipped for the analysis of blood gases, under the direction of Dr. 
Frank D'Elseaux, a Commonwealth Fund Fellow. Stated briefly, the problem 
that has been attacked is as follows: 

It has been demonstrated that certain patients in stupors are brought out of the 
stupor for a short period of time by the inhalation of a high percentage of carbon 
dioxide. Similar effects are also obtained by the use of certain anesthetics such as 
sodium amytal. It is desirable to know the physiological mechanism whereby 
this change of status is accomplished. Therefore, a careful study of the arterial 
and venous blood is made. This study has not been carried to its conclusion, but 
as far as it has gone at the present time, it seems quite evident that when a high 
concentration of carbon dioxide is inhaled, an acute acidosis is produced, which, if 
continued long enough, leads to an acidotic coma, with a considerable fall in the 
hydrogen-ion concentration of the blood. Following this the blood comes to an 
equilibrium once more within the normal limits for the given individual. What 
happens as the result of the barbituric anesthesia has not yet been determined. 
The Fatigue Laboratory, of Harvard University, under the direction of Dr. 
Lawrence Henderson and Dr. David B. Dill, has been most helpful both in giving 
training to Dr. D'Elseaux and in offering assistance and advice at various times. 

As is usually true with a new type of procedure, a number of problems have 
arisen which will need solution, and the work will be continued during the coming 



P.D. 137 



29 



year with Dr. D'Elseaux in charge of the laboratory, and Dr. M. R. Kaufman, who 
worked on the problem in the preceding year, will again be available for the con- 
tinuance of this work. During the past year Dr. Kaufman has been abroad and 
continued his study on this problem, largely*with animal experimentation, in the 
laboratory of Dr. Spiegel in Vienna, and has published a paper with Dr. Spiegel 
on the subject. 

A preliminary report of this work, including that done by Dr. Kaufman, was 
given at the last meeting of the American Psychiatric Association, and will be 
published shortly in the American Journal of Psychiatry. 

In a previous annual report mention was made of experiments in dehydration for 
the treatment of epilepsy. A continuation of these observations has also been 
made during this past year. 

The treatment of neurosyphilis has been continued as in previous years. Dr . 
Arthur Berk, who was in charge of this problem, resigned in order to take another 
position, and was succeeded by Dr. Samuel Epstein. The procedures used have 
been the same as in the preceding year, that is, our major reliance has been on 
malaria and tryparsamide therapy. It may again be reported that more than 
thirty per cent of the paretic patients treated have made very satisfactory im- 
provement, returning to the community, and it is further possible to report that 
there have been practically no relapses in the cases successfully treated in the 
preceding years. 

Recently, there has elsewhere been developed a new method of developing arti- 
ficial fevers by means of diathermy. This method seems to have a good many 
advantages in that it is possible to control better the rise in temperature and it is 
applicable to patients who do not take malaria. Due to the inability to secure 
funds for this work, it has not been possible to carry out this prodecure at the 
Psychopathic hospital during this year. It therefore may not be out of place to 
call attention to the fact that in investigative work it is very inconvenient to be on 
a restricted budgetary allowance without flexibility, a budget that has to be pre- 
pared many months in advance of the time when the contemplated work it to be 
carried out. This means, of course, that one has not the opportunity to make 
modifications in one's work which conditions would seem to demand until a long 
period of time has elapsed. It is hoped in the succeeding year that it will be possible 
to utilize the diathermy method, but this will again depend upon the budgetary 
situation. 

It is a satisfaction to report that the amount of work accomplished in the treat- 
ment of neurosyphilis has increased considerably during this year. There has been 
an opportunity to study the effect of the more modern methods of treatment on 
cases of juvenile neurosyphilis, a problem which has previously not been very well 
studied anywhere. 

The following statistical summary indicates the amount of work done in the 
study and treatment of neurosyphilis: 

House Patients: 

New 185 Ref. from O.P.D 10 1st time this year .. 28 Total 223 

Out-Patients: 

New 22 Ref. from O.P.D 52 1st time this year .163 Total 247 

Relatives: 

New 189 1st time this year ... 8 Total 197 

Visits made by 347 persons 3,527 

Number of individual cases continued for treatment and examination . 673 

Treatments (O. P. D. and House) .... .... 3,099 

Arsphenamine .... 435 Neoarsphenamine 129 

Bismuth 235 Theosulphate ... 11 

Intracistern .4 Tryparsamide . 2,055 

Intraspinal 12 Typhoid vaccine 155 

Malaria 83 Ventriculographies 8 

Mercury 12 



Diagnostic lumbar punctures 



904 



30 



P.D. 137 



Per cent of families followed who were examined 58 % 

Per cent of relatives followed who were examined 59.7% 

Per cent of families examined showing evidence of syphilis . . 28.5% 

Per cent of relatives examined showing evidence of syphilis . . 14.2% 

Pvespectfully submitted, 

HARRY C. SOLOMON, 

Chief of Therapeutic Research. 

REPORT OF THE CHIEF EXECUTIVE OFFICER 
To the Medical Director of the Boston Psychopathic Hospital: 

There has been no important deviation from the established executive routine 
during the past year. Certain minor changes have been introduced here and there 
tending to simplify the work and make it more standardized As usual the cooper- 
ation between the different departments has been excellent. It is becoming in- 
creasingly apparent year after year that the hospital can be administered most 
efficiently by making each employee, no matter what his or her position be, more 
familiar with the problems of administration and keeping before them at all times 
a picture of what an institution of this sort is intended to do and what the taxpayers 
of the Commonwealth are spending about one-quarter of a million dollars per 
annum to accomplish. In the interests of better cooperation it is believed that 
each department should know something of the problems of every other depart- 
ment. For instance an attempt has been made to stimulate some interest among 
the members of the medical staff relative to various executive problems so that 
each one will understand the reason why many requests cannot be granted. For 
the executive merely to tell a medical officer that a certain request cannot be 
granted and not explain the reason why often engenders a feeling of hostility which 
seriously interferes with cooperation. On the other hand the executive is encour- 
aged to see things from the viewpoint of the medical officer. To these ends members 
of the medical staff often substitute for the executive physicians and the latter 
occasionally work up a case for presentation at staff in the same manner as the 
medical officers. The head of each department and to some extent each employee 
is encouraged to familiarize himself or herself with the budget. It is found that if 
each one knows the amount of money he is allowed for equipment, supplies and 
other purposes and is reminded each month of the amount expended and the un- 
expended balance it is much easier to carry on the hospital work in a smooth and 
efficient manner. Of course the Chief Executive Officer has to scrutinize carefully 
each expenditure and frequently does not approve an order. In all cases, however, 
where the order is of any importance the person requesting it is consulted and the 
matter is almost invariably explained or adjusted to everyone's satisfaction. 

The upkeep of building presents a considerable executive problem. Minor re- 
pairs and renewals occur more rapidly than our small force of mechanics is able 
adequately to handle them. In our 1931 budget we have asked for much in the way 
of permanent repairs to the building and have been assured by the Department 
engineers that these matters will receive their approval. The new ice machine for 
which money was granted in 1930 has been bought and is now in process of installa- 
tion. A decided improvement in the interior appearance and sanitation of the 
building has been brought about by the continued services of a painter. Many 
employees' rooms and other parts of the building, not apparent to the casual visitor, 
have been repainted for the first time in over ten years, changing many of the living 
quarters from an untidy and ill-kept appearance to one of cleanliness and attractive- 
ness. There are several parts of the building now in need of new paint but at the 
present rate of progress it is probable that within two years at least the entire 
interior of the building will be brought up to a desired standard which it will be 
comparatively easy for one painter to maintain. During the past year asphalt 
flooring has been laid in all of the rooms for disturbed patients and new doors have 
replaced the original paneled doors in these rooms which had become badly battered 
and very unsightly. All of the protecting screen grills on the ward windows have 
been repainted and resecured. The old iron water mains in the sub-basements have 
been replaced with copper piping. Two new windows have been cut in wards 2 



P.D. 137 



31 



and 3 affording much better light and ventilation in two rooms. Physiotherapy- 
equipment consisting of infra-red and ultraviolet lamps and diathermy apparatus 
has been installed. In the kitchen considerable equipment has been added including 
a Hobart power mixer. 

The passage of over 50,000 cases through this hospital has left a great accumula- 
tion of case histories, pathologic specimens and other permanent records of inesti- 
mable value. These records, old and new, are referred to frequently in the course of 
research and in the making of abstracts for other hospitals, social agencies, insurance 
companies and the like. Filing space long ago became crowded and at present 
presents a serious problem. Space for new laboratory, diagnostic and therapeutic 
equipment is unavailable in the present structure. The increasing number of small 
children admitted makes the establishment of a children's ward highly desirable. 
The storeroom facilities for food and other supplies have been very unsatisfactory 
since this hospital became an independent unit. Unrequisitioned stores are now 
being kept in sev^en diiferent rooms scattered about the building. These are a few 
of the reasons why more floor space is urgently needed and it would seem that the 
building of a moderate sized extension to the present hospital plant could not be 
longer postponed. Such an extension is included in the ten year building programme 
submitted in 1925. It was then proposed to extend the ward 5 wing diagonally 
backward toward the Riverway on property now comprising a part of the hospital 
lawn. The lay of land here would admirably adapt itself to such a project. 

Inasmuch as the year covered in this report is the tenth year of this hospital's 
existence as an independent unit, the following brief statistical summary is sub- 
mitted. During this ten year period there have been 18,367 admissions (exclusive 
of returns from visit, absence or escape.) A large majority of these admissions have 
been for temporary care under the provisions of Sec. 79, C. 123, G. L. The yearly 
average admission rate is therefore 1,836 ; the highest number admitted (2,006) 
being in 1922 and the lowest (1,593) being in 1926. During the other years there 
has been no great deviation from the mean. Just why admissions for 1922 should 
be so much in excess of those for 1926 is a matter that I am unable to explain but 
I venture the opinion that economic conditions, which were considerably better in 
1926 than in 1922, may have had some bearing upon the matter. In the Out- 
Patient Department 10,416 new cases have been examined, a large percentage of 
them making several subsequent visits. The highest number of out-patients (1,135) 
were admitted in 1929 and the lowest number (885) were admitted in 1924. The 
general trend of admissions to the Out-Fatient Department has been upward as 
might be expected. The total number of employees on the hospital payroll in 1921 
was 114, 21 of these being physicians. The number of employees on the payroll 
has gradually increased to 147, 20 of these being physicians. 'The number of workers 
actually at the hospital, however, has increasd considerably more than the number 
actually on the payroll. At the present time there are 23 persons not paid by the 
hospital who are doing scientific work here. The total expenditures for mainten- 
ance have averaged during the last decade $222,567 per annum, amounting at the 
present time to slightly less than $250,000 per annum and showing an increase of 
21.6 - c. Of this amount personal service has been the greatest amounting to nearly 
two-thirds of the total expenditures and showing a ten year increase of 46.5%. 
The average annual expenditures for food have been $31,715 with an increase of 
41.5*^0 since 1921. Medical and general care has cost on an average $17,149 per 
annum with an increase of 33% since 1921. The cost for heat, light and power has 
averaged $12,812 during this period and since 1923 has averaged approximately 
$10,000 per annum. During the years 1921 and 1922 the cost of heat, light and 
power was more than double that of other years due to the great bituminous coal 
strike in operation at that time. Present costs for heat, light and power are 127 % 
less than in 1921. All other items of expense have remained somewhat stationary 
during the last decade. The net weekly per capita cost has averaged $46.23 being 
highest ($56.10) during 1929 and lowest ($39.00) during 1922. The average amount 
of reimbursement received for the care of patients has been $14,244 per annum 
making an average weekly per capita reimbursement of less than $3.19. From 
the above it will be seen that there has been little change in the annual turnover of 
patients during the last 10 years. Indeed there has been little change in the average 



32 



P.D. 137 



annual admission rate since the opening of this hospital as the Psychopathic De- 
partment of the Boston State Hospital in 1912. Expense of operation has increased 
greatly as might be expected. In spite of large expenditures it is seen that patients 
received care at an average individual cost to them of less than 46 cents per day. 
Surely an astonishingly low figure! 

I wish to express at this time my sincere appreciation for the loyalty prevalent 
among the employees of the Boston Psychopathic Hospital and to thank the 
Medical Director for his continued kindness and consideration. To Dr. George M. 
Kline, Commissioner of the State Department of Mental Diseases, and to the 
Assistant Commissioner, Dr. Overholser, I am particularly indebted for wise and 
patient guidance. 

Respectfully submitted, 

ARTHUR N. BALL, 

Chief Executive Officer. 

REPORT OF THE SOCIAL SERVICE DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

During the last year there was a full staff until April, 1930 when Miss Ethel 
Gleason was transferred to the Social Service Department at the Gardner State 
Colony. There were several candidates for the vacancy but due to a deficiency in 
budget it was not possible to fill the position immediately. In June, because of a 
special appropriation the position could have been filled but due to the giving of a 
competitive Civil Service examination no permanent appointments could be made 
until the examinations were corrected and a Civil Service list compiled. Accord- 
ingly, the position remained open until August, 1930 when Mrs. Rena Dewey, who 
had had experience at the Boston State Hospital, was appointed. 

On August 1, 1930 Miss Villa West, clinic manager resigned to become social 
worker in the Neurological Department of the Boston City Hospital. Difficulty 
about filling her position arose as there was no one on the Civil Service list ade- 
quately qualified for the work of clinic manager. When the list was exhausted in 
October, 1930, Miss Annie Porter, a graduate of the Smith School of Social Work 
was appointed. 

On September 30, 1930 Miss Ethel Goodwin resigned to go to the New York 
School of Social Work for one and one-half years of special training. Her position 
was immediately filled by Miss Clara Swain, a recent graduate of the Smith School 
of Social Work. 

In September, Miss Charlotte Nicklin, resigned from the Syphilis Department. 
Her position was filled by Miss Ruth Epstein, a graduate of Boston University. 

In addition to the regular staff, the four students, namely: Miss Grace Finn- 
Brown, Miss Barbara Ashenden, Miss Zitha Rosen and Miss Harriet Parsons, who 
had been studying at the Simmons School of Social Work and working part-time 
under the Laura Spelman Rockefeller Memorial Fund continued their investiga- 
tions of the pre-psychotic personalities of cases of schizophrenia, manic-depressive 
psychoses and general paresis. As partial fulfillment of the requirements for the 
degree of Master of Science, three of these students submitted theses based on 
material which they had gathered during the year and one-half of study. 

Miss Grace Finn-Brown wrote on "The Reliability of Information given by 
Mothers of Sixty Psychotic Patients". W^iile her material did not prove conclu- 
sively that the mother is a reliable or non-reliable source of information it did 
suggest that the anamneses of ignorant unintelligent mothers are inclined to be 
unreliable, not only on subjective material but also on basic facts, such as date of 
birth, date of going to school, heredity, etc. Emotional mothers, although they 
may be biased in their attitude, are usually reliable sources of information. 

Miss Barabara Ashenden wrote on "A Study of the Accuracy of the Estimation 
by Social Workers of the Pre-psychotic Personality Traits in Mental Patients". 
Her thesis was of great interest to those who believe in approaching scientifically 
the matter of gathering information. In the past there has been little attempt to 
evaluate the effect of the worker upon the information obtained. Prejudices, back- 
grounds, points of view, have colored the material, it has been known. On nine 
cases, Miss Ashenden had another social worker listen to the interview and record 



P.D. 137 



33 



independently her impression of the material given, i.e., as to whether the patient 
was extremely jealous or sensitive, or only slightly so. On forty-six items of per- 
sonality there were disagreements in about twenty-eight percent of the instances. 
These were due chiefly to differences between workers in interpretation of defini- 
tions, in willingness to accept informants' statements, and in agreement as to what 
constitutes adequate information. 

Miss Zitha Rosen presented a thesis on "The Statistical Study of Pre-psychotic 
Personality Traits '. She reviewed one hundred cases to see if any significant 
association of traits occurred for the fifty cases diagnosed schizophrenia as com- 
pared with a control group. While the number of the cases was too small for any 
definite statements she did find that there appear to be some consistent, if not 
significant, associations between the cases of schizophrenia and those traits which 
hare been claimed to belong to them, such as day-dreaming, sensitivity, shyness, 
etc. 

Miss Parsons did not submit a thesis but she is writing an article on the effect on 
other members of the family of having one or two members psyciiotic and is dis- 
cussing what the social worker can do to prevent or alleviate the feeling of depression 
and fatalism that often occurs. 

in addition to the four part-time Simmons students there were two full-time 
Master students, ^'iss Elizabeth Marvel and Mrs. Aino Rissanen who also had to 
write theses as partial fulfillment of the requirements for the degree of Master of 
Science. 

Miss Marvel submitted a critical study of f:fty cases of children with reading 
disabilities known either to the Out-Fatient Department of the Boston Psycho- 
pathic Hospital or the Brookline School Survey. Miss Marvel was interested to 
find out whether these children with special difficulties were recognized as having 
academic disabilities or were seen as problem children or children with mental 
deficiency. She found that although the median intelligence quotient v/as ninety- 
three percent the majority were called retarded and were at least one year behind 
in grade placement. The reading level was often two years behind. The children 
were listed as dull, indifferent, would not concentrate, or over-active, a source of 
annoyance to the teacher, or truants. 

Mrs. Rissanen made a study of the cases of sex offenders admitted to the Boston 
Psychopathic Hospital during the year 1929 from six courts in and near Boston. 
Gut of 1938 cases arrested for sex offense only 34 were sent to the hospital for 
examination. Of these, nine were found to be insane and committable but only 
seven were sent on to mental hospitals by the court, the other two being fined or 
placed on probation. Five others were found to be feebleminded, three were sent 
to the State Farm, one to a hospital for the mentally sick and the other to the 
Reformatory for Women. In addition to studying disposition cf the cases, Mrs, 
Rissanen made a brief study of the personalities cf the patients. 

From September, 1929 until the first of June. 1930, Miss Louise Veo and Miss 
Rose Goldsmith, students from the Smith School of Social Work carried on their 
field work under the direction of the department. As partial fulfillment of their 
training, they also wrote theses. Miss Veo presented material on the prognosti- 
cation of mental disease in children. She reviewed eight cases which had been 
studied at the Judge Baker Foundation from three to five years before admission 
to the Boston Psychopathic Hospital. In some cases an early personality involve- 
ment was noted but in no case was there a clear-cut diagnosis of beginning mental 
trouble. The material presented a very interesting study of personality traits in 
the pre-psychotic stages. 

Miss Goldsmith made a study of sixty-three cases sent to the Out-Patient De- 
partment of the hospital during the year 1929 by the Boston Family Welfare Society 
and the Federated Jev/ish Charities in order to ascertain what benefits were received 
from coming to the clinic. She found that in many instances the cases were referred 
chiefly for psychological rating and vocational guidance. Through long contact 
with the families the agency workers felt that they had a good comprehension of 
the personality make-up of the different members of the family group which they 
wished confirmed by the judgment of an expert in personality problems, but that 
they did not expect to receive detailed analytical accounts from the short examina- 



34 



P.D. 137 



tions possible in a busy clinic. In several instances they would have liked more 
concrete advice, especially as to the proper method of handling a psychoneurotic 
individual who would not come to the clinic after the first visit. 

The general routine of the department has been carried on practically as in other 
years, although there has been some attempt made to have "treatment confer- 
ences". In a hospital where there is a frequent change of personal and where many 
of the physicians have had little instruction in psychiatry before coming to the 
hospital it is difficult to plan for careful supervision on the part of psychiatrists of 
students in social work. In order to prevent the social worker from feeling that she 
can work independently efforts are made to arrange as many conferences as possible 
with the physician as to the proper method of dealing with the patient when the 
latter is not directly under the care of the psychiatrist, i.e., when he returns to the 
community or sees the doctor only occasionally. Treatment conferences to which 
come the doctor in charge of the case, the social worker in charge of the case, the 
chief of service, male or female, on which the patient belongs, the chief of social 
service and Dr. Bowman, the medical director, have been arranged in several 
instances with such good results that more will be planned for the coming year. 

In this transition period where there is no clear-cut idea as to the place of psy- 
chiatric social work in the fields of psychiatry and social work and no definite de- 
cision as to whether psychiatric social work is a specialty or not it is interesting to 
study carefully cases which have been handled by psychiatric social workers to see 
what has been the role of the worker and how different her approach has been from 
that of a worker not specially trained in the psychiatric field. 

The following are examples of the case work which members of the Social Service 
Department have been doing this year. 

A.G., a boy of 11, was brought to the Out-Patient Department because of marked 
temper tantrums and an extreme fear of the dark and staircases since the age of 7. In 
addition to being seen in the clinic several times by the psychiatrist, the patient 
and his family were visited at home may times by the social worker. Not only did 
she carry out the psychiatrist's recommendation that he be placed away from the 
surroundings with which he had bad associations by arranging a summer at camp 
and the joining of a boy's club but she also explained to the family time and time 
again that even though they still should accompany him up and down the stairway 
until this fear left, they should do this without making any special comment about 
it. Many explanations were given to the family as to why he had this fear and how 
it had become a habit and that their co-operation was needed in helping him 
recover. He himself was told that as long as he was the older brother and could be 
looked up to that it was his responsibility to keep the smaller children from having 
fears 

J.C., a man of 45, had been admitted to the hospital because he was extremely 
depressed due to unemployment and had compulsive feelings which suggested 
murder, robbery and suicide. At the end of four days he was discharged against 
advice at the request of his wife. On analysis it was discovered that the patient 
was an immigrant Irishman of low intelligence who three years before had been 
transplanted from the simplicity of cQuntry life to the complex environment of a 
city. He had always lived in a primitive condition, had never traveled and was 
unused to the complications of a competitive existence. At first the social worker 
spent her efforts in an attempt to adjust the patient to a simple job where he would 
not constantly be subjected to failures and competition. He had built up an 
antagonism to employers in general and had rationalized his failures by placing the 
blame on others. His good qualities were stressed and many comments were made 
about the little things that he did well. At first, little attention was paid to anyone 
but the patient, the feeling being that it was better to attempt his readjustment 
as an individual even though the family had still to be aided by a family welfare 
society. Later, more attention was paid to his wife and children. The latter had 
been a very successful domestic, well thought of by her employers. After marriage 
she lost courage and showed no efficiency in the care of her own household. An 
attempt was made to give her a degree of satisfaction in keeping her husband suc- 
cessful on his own level and preventing any more breakdowns. Workers who had 
been in charge of the case previously had felt that they must return the family to 



P.D. 137 



35 



Ireland in order to gain happiness for the patient but the psychiatric social worker 
discovered that the patient would regard such a move as a sign of failure on his 
part. Other workers were disturbed because he was not earning enough to entirely 
support the family, not seeming to appreciate that he was capable of only simple 
manual work which would never pay enough to entirely support his wife and three 
children 

E.B., was brought to the Out-Patient Department because at the age of 13 she 
had displayed a sudden lack of interest in school subjects and in her music lessons, 
was pilfering small amounts from the church funds and was getting along very 
poorly with her younger brothers and sisters. On psychological test she was found 
to have an Intelligence Quotient of 91. The mother had hoped that the girl would 
be able to go to college and was constantly urging her to improve her school grades, 
Cn analysis it was discovered that the mother had always wanted to go to college 
herself, not having been able to do so she had planned on having her children go 
and accordingly was much upset when her oldest child, the patient, began to do 
poorly in school. She immediately began to compare her unfavorably with the 
next daughter who is considered very bright. Throughout a year and a half of 
contact with the family much time and effort was spent in explaining to the mother 
that she was projecting her own emotional problems onto her children. Arrange- 
ments were also made for patient to have good musical instruction, for her to get 
away from the home on vacation and to obtain recreation outside of the home. 
Since contact with clinic, patient has taken on many of the household duties for 
which she is receiving praise from the mother. She responds to flattery and it has 
been the task of the social worker to make her feel that she occupies as important 
a position in the school and the home as her younger sister. The father of the 
family was enlisted in the campaign for working out the harmonious relationships 
of the entire group. 

Throughout the year various members of the department have given lectures 
to Family Welfare Societies, parent-teacher associations and mothers' clubs re- 
garding various phases of psychiatric social work. Recently a survey was begun , 
of the Out-Patient cases handled in 1928 to see what has happened since the 
examination at the clinic. It is hoped that by next year some information will be 
at hand regarding the value of even one visit to the clinic by a patient. Some of 
the patients who come for examination seem very ill mentally but do not return. 
The survey should show whether these people became worse and had to be admitted 
to some hospital or whether they gained such an appreciation of their condition 
that benefit was received at once. 

Respectfully submitted, 

ESTHER C. COOK, 

Head Social Worker. 



SOCIAL SERVICE STATISTICS 
I. Numerical summary: 

Male Female 
Children Adults Children Adults 

New cases 209 294 188 241 

Continued from previous year . 47 70 42 54 

Continued to following year .18 33 17 26 

II. Sources of cases: 

Boston Psychopathic Hospital 373 

Out-patient 326 

Research 139 

School survey 94 

III. Analysis of work: 

On June 1, 1930 at the suggestion of the Director of Social Work the 
statistical outline was changed; accordingly, under "Analysis of work" 
the figures are given in two columns, including first from October, 1929 to 
May 31, 1930 and secondly, from June 1, 1930 to September 30, 1930. 
(I) House cases: 

Investigation: 



36 P.D. 137 

Court cases 105 

Outside history because no informant came to hospital ... 83 
Additional social information, i.e., court records, employment, neigh- 
bor, etc 113 

After-care visiting: 

Doing well 59 

Not improved 20 

Readmitted to hospital 6 

Case work, including adjustment in industry, placement in home, finan- 
cial assistance, etc 73 

Out-patient cases: 
Investigation: 

Court cases 18 

History 37 

Slight service, including reference to agencies, consulting with agencies, 

personal services, etc .155 

Case work 60 

(2) 

Number of histories 53 

Number of investigations 125 

Number of visits relative to patients in community 174 

Number of visits relative to patients in hospital 107 

Placements by Social Service: 

1. Number placed 9 

2. Unable to place 3 

IV. Outstanding social problems: 

Diseases: 

Mental 308 

Physical 78 

Personality problems, including temperament, vacillating interests, in- 
stability, etc 227 

Sex problems 66 

Legal problems, including larceny, assault, forgery, etc 112 

Environmental: 

Financial difficulties . . 87 

Employment 110 

Marital difficulties 90 

Unsuitable surroundings, broken home, friction in the home, inade- 
quate physical surroundings, immoral parents 154 

V. Miscellaneous: 

Expense account $580.01 

SOCIAL SERVICE STAFF 
Head Social Worker: Esther C. Cook, July 1, 1928. 

Assistants in Social Service: Villa T. West, June 11, 1928 — resigned July 31, 



1930; Ethel A. Gleason, June 11, 28 — resigned, April 26, 1930; Ethel Goodwin, 
July 8, 1928 — resigned, September 27, 1930; Anne G. Beck, June 25, 1929; Rena 
Dewey, August 25, 1930; Annie Porter, October 13, 1930; Clara Swain, October 
1, 1930. 

Syphilis Follow-up Workers: Charlotte Nicklin, August 5, 1929 — resigned 
August 30, 1930; Ruth Epstein, September 30, 1930. 

REPORT OF THE PRINCIPAL OF THE SCHOOL OF NURSING 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith present the annual report of the Nursing Department for the year 
ending November 30, 1930. 

On Nursing Service. Principal of the school of nursing, 1 ; assistant principal of 
the school of nursing, 1; nurse instructor (full time), 1; female supervisor (night\ 
1; male supervisor (day), 1; assistant supervisors, 2; head nurse, operating room, 



P.D. 137 



37 



1; head nurses, wards, 6; assistant head nurses, 2; student nurses, 14; hydro- 
therapists, 2; female attendants, 8; male attendants, 14. 

Head Nurses resigned: Miss Abbie Urquhart, Miss Dorothy Allen and Miss 
Margaret McKay. 

Head Nurses appointed: Miss Helen Brougham, a graduate of the New England 
Deaconess Hospital, Miss Margaret de Grouchey, a graduate of the Winchester 
Hospital and Miss Muriel Kew, a graduate of Newton Hospital. These nurses have 
taken the affiliated course here. 

During the year we received fifty-four student nurses and one graduate nurse 
for the three months course in psychiatric nursing. 

Special Nursing: Number of special nurses, 12. Total of number of weeks in 
wards, 2C. 

Hydrotherapy: Tonic baths, number of patients, 251; foot bath, 724; salt 
glows, 887; electric light baths, 4r8; sitz baths, 111; saline baths, 118; hot and 
cold applications, to spine, 74; wet sheet packs (as preparatory treatment), 21; 
baking and massage, 26; tub shampoos, 575; head shampoos, 442; rain douches, 
441; scotch douches, 74; Continuous baths: Number of patients, 462; number 
of baths, 2;422; number of hours, 15, 374. Wet sheet packs: Number of patients, 
57; number of packs, 175; number of hours, 522. 

Instruction in wet sheet packs, tonic baths and continuous baths was given to 
56 nurses, number of lessons, 360; number of hours, 374. Instruction in wet sheet 
packs and continuous baths was given to 28 male attendants, number of lessons, 
91; number of hours, 161. 

The routine work in the nursing department has varied little from that of the 
previous year. We are invariably meeting with difficult nursing problems and in 
order to give the excited, physically ill patients, including many post partum cases, 
proper nursing care, we have been obliged to place most of our student nurses on 
the female receiving ward, thus leaving a shortage of nurses on the other wards. 
We need at least four more student nurses, but since we have no means of housing 
them, we cannot take them on the service. 

Affiliation with the general hospitals is continuously proving successful. The 
manner in v/hich the student nurses adapt themselves to this type of nursing is 
very satisfactory. Their wholesome attitude towards the work is stimulating and 
beneficial and contributes a great deal in bringing about satisfactory results in the 
treatment of our patients. 

The Vvinchester Hospital is continuing to send us four student nurses instead of 
two every three months, which is a gratifying evidence of the value the general 
hospital is placing in our educational course in mental nursing. 

The doctors' efforts have been untiring in contributing to our lecture course, 
and I wish to thank them on behalf of the nursing service for their splendid work 
which has been so satisfactory and helped to make our affiliative course during 
the past year so successful. 

Miss Sigrid Bradgon, a student nurse from the Winchester Hospital, whose 
affiliation here was interrupted due to illness, was sent back to her own hospital 
where she died of spinal meningitis. During her affiliation here her work was of 
the highest type: such women are indeed a loss to the nursing world. 

Our graduate nurses have shown a greater interest in establishing a more pleasant 
environment for our patients. Since the wards have been repainted, they have, 
with the aid of the Occupational Therapy Department, gotten many pillows, 
tapestries, and window draperies of colorful designs, which tend to give our wards 
a more homelike appearance. 

I wish to thank the medical and executive staffs for their encouragement and 
support, also the members of the other departments for their cooperation during 
the year. 

Respectfully submitted, 

MARY FITZGERALD, R.N., 
Principal of the School of Nursing. 



38 



P.D. 137 



REPORT OF THE DEPARTMENT OF OCCUPATIONAL THERAPY 
To the Medical Director of the Boston Psychopathic Hospital: 

During the year this department has furnished occupational therapy for all 
house patients who are able to be brought to the work rooms. This usually com- 
prises about one half of the resident population. Work is done on the wards as 
the personnel permits. From the point of view of occupational therapy there is ,' 
an important difference between the cases that remain in the hospital for ten days 
or less and those that stay for longer periods. For the former group we feel that 
we have accomplished our purpose if we can make them feel that the hospital ex- 
pects them to busy themselves about normal interests and to react to the situation ■ 
in which they find themselves with something approaching normal behavior. Our 
contact with these patients should help to establish their confidence in the activities 
of the institution. 

However, it is with the group that remains for a longer period that we are able 
to make some effort to gauge the results of our work. In attempting to estimate 
the importance of occupational therapy we find it difficult to separate any one ele- 
ment in the treatment of a patient and to make any accurate appraisal of the result. 
In the majority of cases the hospital situation appears to act upon the patient as : 
a unit. While we should like to be able to isolate the results of our work and to 
say that this occupation will produce this effect upon a patient of a given type we 
do not feel that at this stage such a formulation is possible. On the contrary we 
find that our work cannot be estimated as a detached therapeutic agent. Very , 
often the attitude of the patient toward occupational therapy is strongly influenced j 
by his attitude toward the physician or by some situation on the ward. In the 
same way his interest in occupational therapy should carry over into his attitude i! 
towards the hospital as a whole. 

In many cases the value of the work is obvious to the patient himself. He • 
recognizes it as a training in concentration and as a means of maintaining his 
interest in things about him. He accepts the work as a form of treatment. In ^ 
other cases he must be urged to activity of some sort. He may undertake a project 
because he wishes to keep the thing to be made for himself or for some friend. He 
may even work to please the instructor or just because it seems to be expected of 
him. The details of one or two cases may show how our work is carried on and 
how closely we come in contact with the patient: 

I.R. A young man of 23 comes into the department with a history of diflficulty i 
in making satisfactory adjustments both social and occupational, and with a i 
gradual deterioration in his behavior. 

November 18, 1929. On entry to the department the patient seems retarded in i 
his activities, he moves slowly, talks little and presents a dull and listless appearance. ^ 
The therapist talks to patient and gets him to sit down in the work room. Patient ' 
is allowed time to become adjusted to the new surroundings, and then a waste j 
basket which is partly done is given him. A finished model is shown, and it is i 
suggested that he complete the new one. He accepts the work. The process is 
explained and the patient learns a simple weave. He works slowly, and at first i 
makes many mistakes, working only a short while at a time. Occasionally he 
breaks down and cries. 

December 2, 1929. Patient works more readily, makes few mistakes and moves 
with fair rapidity. He still seems to talk with difficulty. He goes without things 
he wishes to work with rather than ask for them, and practically never speaks on 
his own initiative. He will answer questions fairly readily. Patient has finished 
his waste basket and undertakes caning a chair. He usually appears somewhat 
anxious and depressed; it is noticed that he occasionally smiles to himself without 
apparent cause. i 

January 6, 1930. Patient becomes more flexible in his work. Therapist is able | 
to give him work of varying sorts. He is placed with a group of men engaged in j 
the project of printing a calendar. Patient is employed on such processes as cutting j 
paper for printing, counting prints, running the printing press, etc. Work is j 
changed frequently because therapist wishes to give him something which will i 
require concentration, and will train him in adapting to varying requirements. It ' 
was found impossible to make too great demands upon his intelligence in the ; 



P.D. 137 



30 



handling of material. Patient begins to talk more freely to therapist. When 
asked what he was thinking about when he was seen smiling while cutting paper, 
he said he was thinking that "maybe it might be money." However he stated the 
correct use for the paper when questioned. "When asked why he did not talk more 
freely to others he said that it took time to get acquainted, and that he could 
talk to therapist because he had been in the department long enough to get to 
know her. At this time patient worked steadily throughout the hour with fair 
reliability. 

After about three months the patient was transferred to another state hospital. 
In this case, while there was nothing approaching cure, still the patient did show 
improvement in the level of his work, and also in his relationship to those with 
whom he came into contact. 

Another case with a different outcome is as follows: 

T.R. A man of thirty-seven, a mechanical worker of fair grade, breaks down 
into a rather acute condition of confusion, showing many distorted ideas. 

November 20, 1929. When brought to the department the patient appears 
agitated and confused. He is given a dish-mop handle to sandpaper. After a few 
minutes he takes work to the sink and soaks wood and sandpaper in water. Then 
he picks up a shellac brush another patient is using and tries to shellac the wet 
wood. At times he insists on keeping the thumb and forefinger of his right hand 
tightly closed, refusing to open his hand. When asked the reason he says, "must 
not let go." He remains in the department the first day for only a short time, 
then is returned to the ward. 

December 15, 1929. Patient comes to department regularly and wishes to be 
busy all the time. He is engaged in a variety of simple occupations which require 
some concentration upon technique. He canes a chair, is interested in making a 
work-basket for his wife, and does weaving upon a rug loom. Patient is slow in 
his work, and seems to have difficulty in concentrating on what he is doing. Seems 
very conscientious and anxious to please, worries lest he is not doing what is ex- 
pected of him. Wishes for minute directions and takes an unusually submissive 
attitude. Asks for permission when he wishes to leave the room, and repeatedly 
says, "I'll do what you say, you know best." 

March 30, 1930. Patient works more freely and with fewer signs of anxiety. 
Patient is doing woodwork, using material from packing boxes to make a telephone 
stand. Also operates the hand printing press. Learns more readily and uses 
better judgment. Still shows some residue from his former condition, is slow, 
perplexed by anything he does not quite understand, and easily fatigued. On the 
whole he shows considerable improvement in his general attitude and in his ability 
to deal with concrete material. 

Patient is discharged much improved, goes back to his family and is able to 
carry on at apparently as high a level as before his illness. This man is described 
as naturally energetic, ambitious, and never happy except when he is doing some- 
thing*. For a patient of this type occupational provision of some sort would seem to 
be a factor of considerable importance. 

During about half of the year we have had with us students from the Boston 
School of Occupational Therapy for varying periods of training. We have also 
continued to receive into the department for two weeks training the student nurses 
who are affiliated with the hospital. During this time they have a chance to see 
the workings of the department, as well as to learn something of one or two crafts 
which may be of use to them in cases where occupational work is indicated. The 
recreational program has consisted of dances which have been attended by a large 
number of the hospital population both patients and employees. We have also had 
a good number of parties for the patients in the sunparlor of the department at which 
we have made use of moving pictures and community games. The addition of a 
moving picture machine to the equipment would greatly extend our recreational 
opportunities. The department oversees the distribution of magazines to the 
various wards. In this work we are greatly aided by contributions from the Lend- 
a-hand Society of Boston. 

An exhibition of work was recently sent to the annual convention of the Massa- 
chusetts Occupational Association, and an article was contributed by the chief 



40 



P.D. 137 



therapist to the November Bulletin of this society in a symposium upon "Interior 
Decorating in the Mental Hospital as a Therapeutic Measure." 

A loom has recently been purchased for the department, and the sunparlor has 
been redecorated during the year. 

The personnel of the department is unchanged, Miss Dorothy Hayden having 
continued her efficient services. 

The statistics of the Department are as follows: 

Attendance — Women — Average attendance, 20. Total enrollment, 606. 
Attendance — Men — Average attendance, 19. Total enrollment, 624. 
Articles made, 1,950. Forms printed, 22,650. 

Respectfully submitted, 

ETHELWYN F. HUMPHREY, 

Chief Occupational Therapist. 

PUBLICATIONS FROM THE CLINICAL SERVICE AND LABORATORIES 

Beck, S. J. — "The Rorschach Test and Personality Diagnosis. I. The Feeble- 
minded." American Journal of Psychiatry, Vol. 10, No. 1, July 1930, 19-52. 

Campbell, C. Macfie — "Psychiatry and the Medical Student." Psychiatric 
Quarterly, January 1930. 

Campbell, C. Macfie — "Hallucinations; Their Nature and Significance." 
American Journal of Psychiatry, Vol. 9, No. 4, January 1930. 

Campbell, C. Macfie — "Some Errors in the Diagnosis of Schizophrenia." 
Archives of Neurology and Psychiatry, Vol. 24, No. 1, July 1930. 

Campbell, C. Macfie — "The Work of the Psychopathic Hospital." Inter- 
national Congress of Mental Hygiene, May 5-10, 1930. 

Kaufman, M. Ralph and Spiegel, E. A. — " Experimentelle Analyse der Bee- 
inf^ussung Katatoner Zustande durch Einatmen von Kohlensaure-Sauerstoff- 
mischungen." Ztschr. f. a. ges. Neur. u. Psychiatr., Vol. 1, No. 2. 

Wells, F. L. — "Guidance of Normal Adolescents." Monthly Bulletin of the 
Massachusetts Society for Mental Hygiene, Vol. 8, No. 3, December 1929. 

Wells, F. L. — "New Problems in Psychometrics. " Reprinted from the Pro- 
ceedings of the Fifty-fourth Annual Session of the American Association for the 
Study of the Feebleminded held at Washingt(^n, D. C, May 5-7, 1930. 

Wells, F. L. — "A Short-Answer Exammation in Psychiatry." Journal of 
Genetic Psychology, Vol. 37, June 1930, 309-314. 

Wells, F. L. — "Effects of Instruction on Test Performance." Journal of 
Genetic Psychology, Vol. 37, June 1930, 314-317. 

Wells, F. L. — "Comparative Reliability in Tests of a Motor Aptitude." 
Journal of Genetic Psychology, Vol. 37, June 1930. 318-331. 



VALUATION 

November 30. 1930 



Real Estate 

Land. 2 acres $59,300.00 

Buildings 553.568.68 



$612,868.68 

Personal Property 

Travel, transportation and office expenses $3,648.44 

Food 3.095.27 

Clothing and materials 1.634.75 

Furnishings and household supplies 23.170.96 

Medical and general care 20.460.08 

Heat, light and power 734.50 

Farm -00 

Garage, stables and grounds 136.25 

Repairs 1,273.68 

$54,153.93 

Summary 

Real estate $612,868.68 

Personal property 54,153.93 



$667,022.61 



P.D. 137 41 

FINANCIAL REPORT 
To the Department of Mental Diseases: 

1 respectfully submit the following report of the finances of this institution for 
the fiscal year ending November 30, 1930. 

Cash Account 



Receipts 

Income 

Board of Patients $11,667.07 

Reimbursements 1,464.58 

$13,1.31.65 

Personal Services: 

Reimbursement from Board of Retirement 109.00 

Sales: 

Food 118.15 

Repairs, ordinary 16.19 

Arts and crafts, sales 29.99 

Total sales $164.33 

Miscellaneous: 

Interest on bank balances $228.21 

Rent 1,800.00 

Sundries 198.00 

$2,226.21 



Total Income $15,631.19 



Maintenance 

Balance from previous year, brought forward $4,314.38 

Appropriations, current year 255,850.00 

Total $260,164.38 

Expenses (as analyzed below) 248,856 .79 

Balance reverting to Treasury of Commonwealth $11,307.59 



Anait/sis of Expenses 

Personal services $161,455.61 

Religious instruction 480.00 

Travel, transportation and office expenses 5.698. 10 

Food 36.411.44 

Clothing and material 1 .292 . 03 

Furnishings and household supplies 4,863.54 

Medical and general care 18,550.00 

Heat, light and power 11,001.65 

Garage, stable and grounds 292 . 59 

Repairs ordinary 3,992.83 

Repairs and renewals 4,819.00 



Total expenses for Maintenance $248,856.79 

Special Appropriations 

Balance December 1. 1929 $169 .25 

Appropriations for current year ■ 

Total $169.25 

Expended during the year (see statement below) vS155 .97 

Reverting to Treasury of Commonwealth 155,97 



Balance November 30, 1930, carried to next year $13 .28 



Object 


Act or Resolve 


Whole 
Amount 


Expended 

During 
Fiscal Yr. 


Total 
Expended 
to Date 


Balance 
at End 
of Year 


X-ray Equipment. 


Chap. 127, Sec. 5. Acts of 1928 


$5,800.00 


$155.97 


$5,786.72 


$13.28 



Per Capita 

During the year the average number of inmates has been, 86.40. 

Total cost of maintenance, $248,856 .79. 

Equal to a weekly per capita cost of $55.39 

Receipts from sales. SI 64. 33. 

Equal to a weekly per capita of $.0365. 

All other institution receipts $15,466.86. 

Equal to a weekly per capita of $3.4425. 

Net weekly per capita $51.91. 

Respectfully submitted, 

ELIZABETH LIBBER SHORE, 
Treasurer. 



42 P.D. IS* 

STATISTICAL TABLES 

As Adopted by the American Psychiatric Association 
Prescribed by the Massachusetts Department of Mental Diseases 

Table 1. General Information 

Data correct at end of hospital year November 30, 1930 

1. Date of openivg as a hospital for mental diseases, June 24, 1912. 

2. Type of hospital: State. 

3. Hospital plant: 

Value of hospital property: 

Real estate, including buildings $612,868.6;' 

Personal property 54,153 .9. 

Total $667,022.6 

Total acieage of hospital property owned, 2 acres. 

4. Officers and Employees (November 30, 1930) 

Actually in Service at Vacancies at End 

End of Year of Year 

M. F. T. M. F. T. 

Superintendents 2 - 2 - - 

Assistant physicians 5 2 7 1 - 1 

Medical internes 3 - 3 - - 

Clinical assistants 5 1 6 1 - 1 

Total physicians 15 3 18 2 - 2 

Resident dentists 1 - 1 - - - 

Graduate nurses 2 12 14 - - 

Other nurses and attendants ... 16 16 32 - 3 3 

Occupational therapists - 2 2 - - - 

Social workers - 5 5 - 1 1 

All other officers and employees ... 23 46 69 1 - 1 

Total officers and employees ...57 84 141 3 4 7 

Note: — The following items, 5-10, inclusive, are for the year ended September 30, 1930. i 

5. Census of Patient Population at end of year: 

Absent from Hospital 
Actually in Hospital but Still on Books 

White: M. F. T. M. F. T. 

Insane 32 22 54 36 23 59 

Epileptics - 3 3 - - 

Mental defectives 2 2 4 

All other cases 4 8 12 1 5 6 

Total 38 35 73 37 28 65 

Other Races: 

Insane 3 - 3 1 1 2 

Total 3 - 3 1 1 2 

Grand Total 41 35 76 38 29 67 

Males Females Total 

6. Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 22 20 42 

7. Other patients employed in general work of hospital on date of report - - - 

8. Average daily number of all patients actually in hospital during year. 45 .99 39.23 35.22' 

9. Voluntary patients admitted during year 38 25 63 

10. Persons given advice or treatment in out-patient clinics during year . 647 751 1,398 

Note: — The following tables 3-19, inclusive, are for the Statistical year ended September 30, 1930. 

Table 2. Financial Statement 



See Treasurer's report for data requested under this table. 



43 

















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44 P.D. 137 

Table 4. Nativity of First Admissions and of Parents of First Admissions. 



Nativity 


Patients 


Parents of 
Patients 


Male 


Parents 
Patients 


07 


Femai-E 


M. 


F. 


T. 


Fathers 


Both 

Mothers Parents 


Both 

Fathers Mothers Parents 


United States 


69 


58 


127 


36 


31 


28 


21 


25 


19 


Australia .... 












~ 








Canada * . . . . 


5 


4 


9 


8 


10 


6 


11 


12 


11 


China 


1 




1 


1 


1 


1 


~ 




— 


England .... 


2 




2 


2 


4 


2 


2 


2 


1 


France ..... 








1 












Germany .... 






~ 


1 












Greece 


1 


- 


1 


1 


1 


1 








Ireland .... 


4 


4 


8 


20 


25 


20 


23 


18 


16 


Italy 


4 


2 


6 


7 


7 


7 


4 


4 


4 


Jugoslavia .... 
















1 




Mexico .... 








1 












Norway .... 




1 


1 




1 




1 






Portugal .... 




1 


1 


2 


2 


2 


1 


1 


1 


Russia 


3 


1 


4 


3 


3 


3 


6 


6 


6 


Scotland .... 


1 


1 


2 


2 


2 










Wales 
















1 




Other countries 


2 


2 


4 


3 


3 


3 


1 


1 


1 


Unascertained . 








3 


2 


2 


4 


3 


3 


Total .... 


92 


74 


166 


92 


92 


76 


74 


74 


62 



^Includes Newfoundland. 



P.D. 137 



45 




46 



P.D. 137 



Table 5. Citizenship of First Admissions. 

Males Females Total 



Citizens by birth 




69 




58 




127 ' 


Citizens by naturalization 




11 








18 \ 


Aliens 




10 




9 




19 ■ 


Citizenship unascertained 




2 








2 i 


Total 




92 




74 




166 


Table 6, Psychoses of First Admissions. 












Psychoses 


M. 


F. 


T. 


M. 


F. 


T. 




1. Traumatic psychoses 








2 


— 


2 


2. Senile psychoses 








— 


— 


— 


3. Psychoses with cerebral arteriosclerosis 








1 


— 


1 


4. General paralysis 








41 


1 


42 


5. Psychoses with cerebral syphilis ; 








2 


2 


2 


6. Psychoses with Huntington's chorea 








- 


- 


- 


7. Psychoses with brain tumor 








— 


2 


2 1 


8. Psychoses with other brain or nervous diseases, total .... 








1 


4 


5 


Tabes dorsalis 


- 


1 


i 


- 


- 


- 


Other diseases 


1 


3 


4 


— 


— 


— ■ 


9. Alcoholic psychoses total 


. . . . 






5 


— 


5 


Delirium tremens 




- 


1 


- 


- 


- , 


Acute hallucinosis 


2 




2 








Other types, acute or chronic 


2 




2 


- 


- 


- ■' 


10. Psychoses due to drugs and other exogenous toxins, total 








5 


2 


7 


Opium (and derivatives), cocaine, bromides, chloral, etc. alone or 














combined 


4 


2 


6 


- 




- • 


Gases 


1 


~ 


1 








11. Psychoses with pellagra 












~ ■ 


12. Psychoses with other somatic diseases, total 








1 


13 


14 \ 


Post-infectious psychosis 


- 


1 


1 








Exhaustion delirium 


1 


~ 


1 








Cardio-renal diseases 


- 


1 


1 








Other diseases or conditions ......... 




11 


11 


- 


— 




13. Manic-depressive psychoses, total 








7 


14 


21 


Manic type 


1 


5 


6 








Depressive type 


3 


7 


10 








Other types 


3 


2 


5 


- 






14. Involution melancholia 








1 


4 


5 


15. i^ementia praecox (schizophrenia) 




- 




18 


14 


32 


16. Paranoia and paranoid conditions 








1 


4 


5 


17. Epileptic psychoses 














18. Psychoneuroses and neuroses, total 










1 


1 


Other types 




" i 


1 








19. Psychoses with psychopathic personality 










1 


1 


20. Psychoses with mental deficiency 










2 


2 


21. Undiagnosed psychoses 








9 


9 


18 


22. Without psvchosis, total 




.... 






1 


1 


Others 


















92 


74 


166 



P.D. 137 47 



Table 7. Race of First Admissions Classified with Reference to Principal Psychoses. 



Race 




Total 


Traumatic 


With 
cerebral 
arterio- 
sclerosis 


General 
paralysis 


With 
cerebral 
syphilis 


With 
brain 
tumor 




M. 


F. 


T. 


M. F. 


T. 


M. F. 


T. 


jSI. 


F. 


T. 


M. F. 


T. 


M. F. 


T. 


African (black) .... 


3 


2 


5 


- - 


- 


- - 


- 


2 


- 


2 










Chinese 


1 


— 


1 


— — 


— 


— — 


- 


1 




1 










English 


16 


14 


30 






1 - 


1 


5 




5 


- 1 


1 






French 


- 


3 


3 
























Greek 


1 




1 










1 


- 


1 










Hebrew 


4 


6 


10 


1 - 


1 


- - 


- 


3 




3 


- 1 


1 






Irish 


31 




oo 


1 — 


1 






Q 
O 










_ 2 


2 


Italian ' 


7 


4 


11 










6 




6 










Lithuanian .... 


1 




1 










1 




1 










Pacific Islander ... 




1 


1 
























Portuguese .... 


2 


1 


3 










1 




1 










Scotch 


4 




4 










3 




3 










Slavonic • 


1 


1 


2 
























Other specific races . 


1 




1 










1 




1 










Mixed 


16 


8 


24 










8 




8 










Race unascertained . 


4 


2 


6 










1 


1 


2 










Total 


92 


74 


166 


2 - 


2 


1 - 


1 


41 


1 


42 


- 2 


2 


- 2 


2 



^Includes "North" and "South". 

^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



Table 7. Race of First Admissions Classified with Referenceto Princip al 

Psychoses — Continued. 



Race 


With other 
brain or 
nervous 
diseases 


Alcoholic 


Due to drugs 
and other 
exogenous 
toxins 


With 
other 
somatic 
diseases 


Manic- 
depressive 


Involution 
melancholia 




M. F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


African (black) 


- 1 


1 
















1 


1 














Chinese 




































English . 


2 


2 








2 




2 




1 


1 


2 


2 


4 




1 


1 


French . 




















1 


1 




1 


1 








Greek 




































Hebrew 


























1 


1 








Irish 


1 1 


2 


5 




5 


1 


2 


3 


1 


5 


6 


3 


6 


9 




3 


3 


Italian'. 




















2 


2 














Lithuanian 




































Pacific Islander 




















1 


1 














Portuguese . 






























1 




1 


Scotch . 




































Slavonic 2 












1 




1 




















Other specific races 




































Mixed 












1 




1 




2 


2 


2 


3 


5 








Race unascertained 


























1 


1 








Race 


1 4 


5 


5 




5 


5 


2 


7 


1 


13 


14 


7 


14 


21 


1 


4 


5 



'Includes "North" and "South". 

''Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian. Polish, 
Russian. Ruthenian, Servian, Slovak, Slovenian, 



48 



P.D. 137 



Table 7. Race of First Admissions Classified with Reference to Prirxijiol 
Psychoses — Continued. 











Paranoia 


Psycho- 
















Dementia 




and 


neuroses 


With 


With 


Undiagnosed 


Without 


Race 


praecox 


paranoid 


and 


psychopathic 


mental 


psychoses 


psychosis 










conditions 


neuroses 


personality 


deficiency 












M. 


F. 


T. 


iVi 




-■ 

M. F. T. 


M. F. T. 


M. F. T. 


M. 


F. 


T. 


M. F. T. 


African (black) . 


















1 




1 




Chinese 


























English . 


4 


2 


6 




1 1 


- 


1 1 


- 1 1 


2 


2 


4 


- - - 


French . 




















1 


1 




Greek . 


























Hebrew 




3 


3 














1 


1 


- - - 


Irish 


6 


5 


11 


1 


2 3 


- 1 1 






4 


4 


8 


- 1 1 


Italian i 


1 


1 


2 




1 1 
















Lithuanian . 


























Pacific Islander . 


























Portuguese . 




















1 


1 


_ _ _ 


Scotch . 


1 




1 




















Slavonic ^ 




1 


1 




















Other specific races 


























Mixed . 


5 


2 


7 










- 1 1 










Race unascertained 


1 




1 












2 




2 




Total 


18 


14 


32 


1 


4 5 


- 1 1 


- 1 1 


- 2 2 


9 


9 


18 


- 1 1 



^Includes "North" and "South". 

^Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian, Servian Slovak, Slovenian. 



Table 8. Age of First Admissions Classified with Reference to Principal Psychoses. 











Under 




15-19 






20-24 




Psychoses 




Total 


l.S 


years 




years 






years 






M. 


F. 


T. 


M. F. T. 


M. 


F. 


T. 


M. 


F. 


T. 




2 




2 












1 




1 


2. Senile 
























3. With cerebral arteriosclerosis .... 


I 




1 


















4. General paralysis 


41 


1 


42 


1 


- 1 


1 




1 


2 




2 


5. With cerebral syphilis 




2 


2 


















6. With Huntington's chorea .... 




























2 


2 


















8. With other brain or nervous diseases 


1 


4 


5 








1 


1 








9. Alcoholic 


5 




5 


















10. Due to drugs and other exogenous toxins 


5 


2 


7 


















11. With pellagra 
























12. With other somatic diseases .... 


1 


13 


14 














2 


2 




7 


14 


21 








3 


3 


3 


3 


6 




1 


4 


5 




















18 


14 


32 




1 1 


3 


2 


5 


8 


4 


12 


16. Paranoia and paranoid conditions . 


1 


4 


5 


















17. Epileptic psychoses 
























18. Psychoneu roses and neuroses .... 




1 


1 


















19. With psychopathic personality 




1 


1 








1 


1 








20. With mental deficiency 




2 


2 








1 


1 








21. Undiagnosed psychoses 


9 


9 


18 






3 


3 


6 


2 


1 


3 


22. Without psychosis 




1 




















Total 


92 


74 


166 


1 


1 2 


7 


11 


18 


16 


10 


26 



P.D. 137 



49 



Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses — Continued. 







25-29 






30- 


34 


3.5-39 




40-44 


Psychoses 




years 






years 




years 







years 







M. 


F. 


T. 


xM. F. 


T. 


M 


F. 


T. 


M 


F. T. 


1. Traumatic 
























2. Senile 
























3. With cerebral arteriosclerosis .... 
























4. Genera! paralysis 


3 


1 


4 


3 




3 


5 


— 


5 


10 


- 10 


With cerebral syphilis 


- 


- 


- 




1 


1 




































7. With brain tumor 
























8. With oiher brain or nervous diseases . 
























V. -Mcoholic 


- 


- 










3 


- 


3 


- 


- - 


10. Due to drugs and other exogenous toxins 














3 


— 


3 


1 


- 1 


























12. With other somatic diseases 


- 


1 


1 




1 


1 


- 


3 


3 


- 




13. Manic-depressive 


- 


2 


2 


1 


2 




1 


1 


2 




I I 


14. Involution melancholia 
























15 Dementia praecox 


5 


3 


8 




1 


1 


2 


2 


4 


_ 


1 1 


16. Paranoia and paranoid conditions 




1 


1 




1 


1 


1 




1 






17. Epileptic psycho.ses 
























18. Psychoneuroses and neuroses .... 










1 


1 












19. W !th psychopathic personality .... 
























20. With mental deficiency 




1 


1 




















1 


2 


3 








1 


1 


2 




1 1 


22. Without psychosis 




1 


1 


















Total 


9 


12 


21 


4 


7 


1. 


16 




23 


11 


3 14 



Table 8. Age of First Admissions Classified zvith Reference to Principal 
Psychoses — Concluded. 





45-49 




50- 


54 




55- 


59 


60-64 


Psychoses 




years 






years 




years 


years 




M. 


F. 


T. 


M. F. 


T. 


M. F. 


T. 


M. F. T. 


1. Traumatic 








1 




1 










2. Senile . 






















3. With cerebral arteriosclerosis 




















1 - 1 




11 




11 


4 




4 


1 




1 




5. With cerebral syphilis 
















1 


1 


























7. With brain tumor 
















2 


2 




8. With other brain or nervous diseases 










3 


3 


1 




1 




9. Alcoholic . 


1 




1 


1 




1 










10. Due to drugs and other exogenous toxins . 


1 




1 




2 


2 










1 1. With pellagra 






















; 2. With other somatic diseases 




1 


1 




2 


2 


1 


3 


4 








2 


2 


2 




2 










i4. Involution melancholia 


1 


1 


2 




2 


2 




1 


I 




1 5. Dementia praecox 






















16. Paranoia and paranoid conditions .... 




1 


1 










1 


1 




17. Epileptic psychoses 






















1 8. Psychoneuroses and neuroses 






















19. With psychopathic personality 






















10. With mental deficiency 






















11. Undiagnosed psychoses 


1 


1 


2 








1 








12. Without osychosis 






















Total 


15 


6 


21 


8 


9 


17 


4 


8 


12 


1 - 1 



50 



P.D. 13 



c 2 


M. F. T. 


1 


1 1 1 
1 1 1 


^111 
1 — 1 1 


1 1 1 1 i 
1 1 1 1 1 
1 1 1 1 1 


l 1 1 1 1 

1 1 1 I 1 
1 1 1 1 1 






H 




1 - 1 


1 1 - 1 


1 1 O (N 


1 1 1 cs 1 


o 








1 1 1 


1 1 1 1 


1 CS 1 ^ CS 


1 1 1 ^ 1 


o 


s 






1 - 1 


1 1 - 1 


1 CS 1 ir: 1 


1 1 1 - 1 


o 








1 1 


1 — — CS 


tN O — C — 


- 1 1 OC 1 




^ "o 

2 

= cH 








1 — 1 1 


es vO — O 1 


— 1 1 ■* 1 


cs 
cs 




IS 




1 v2 1 


1 1 — cs 


1 •* I -H 


111"*! 


cs 
cs 


mmon 
:hool 






— O' «N 
CM 

1 1 fM 


w r<1 ir; 
— CO 1 CS 


— vC — 
O vO — 


1 — cs -o — 

1 ^ cs <*5 »-H 


IT) 

c 
cs 




:^ 






1 1 <^ f*> 


^ — — OS 1 


1 1 1 «*> 1 




Is and 






1 - 1 


. , , , 
.,11 


1 1 1 1 - 
1 1 1 1 - 


1 1 1 - 1 
1 1 1 - 1 


cs 


















o > 






1 - 1 


1111 


11111 


1 1 1 1 1 






H 




1 •* 1 


1.11 


1 1 1 1 


111-1 




litera 






1 1 I 


1 1 1 1 1 


-^1111 


11111 


-* 
























— ^ <N 




^ cs ' ?5 


--.00- 




Tota 






1 CS 


1 CS 1 CS 


1 ■<* Tj- Tf 












— ^ 1 


1 — lO IT! 


1 -Ht^ —00-l 


1 1 1 1 0> 1 


1 cs 



i: o 



'-.Ha; u tS a; 



22 

C. 

2 " 



6 o 



't O t-»' 00 0> O 



a c 

^ O C, fc M 



■vz 

3'^ 



P.D. 137 51 



Table 10. Environment of First Admissions Classified with Reference to Principal 

Psychoses. 



Psychoses 


Tota 


1 


Urban 


Rural 


Unascertained 






M. 


F. 


T. 


M. 


F. 


T. 


M. F. 


T. 


AT IT T 


1. 


Traumatic 


2 




2 


2 




2 








2. 






















3. 


With cerebral arteriosclerosis 


1 




1 








1 - 


1 




4. 


General paralysis 


41 


1 


'±1, 


40 


1 


41 


1 - 


1 




5. 


With cerebral svphilis 




2 


2 




2 


2 








6! 


With Huiitington's chorea .... 




















7. 


With brain tumor 




2 


2 




2 


2 








8. 


With other brain or nervous diseases . 


1 


4 


5 


1 


4 


5 








9. 


Alcoholic 


5 




5 


5 




5 








10. 


Due to drugs and other exogenous toxins 


5 


2 


7 


5 


2 


7 








11. 


With pellagra 




















12. 


With other somatic diseases 


1 


13 


14 


1 


13 


14 








13. 


Manic-depressive 


7 


14 


2 1 


7 


13 


20 


- - 


- 


— 1 1 


14. 


Involution melancholia .... 


1 


4 


c 



1 


4 


5 








IS. 


Dementia praecox 


18 


14 


32 


18 


13 


31 


- 1 


1 


_ _ _ 


16. 


Paranoia and paranoid conditions 


1 


4 


5 


1 


4 


5 








17. 


Epileptic psychoses 




















18. 


Psychoneuroses and neuroses 




1 


1 




1 


1 








19. 


With psychopathic personality . 




1 


1 




1 


1 








20. 


Witii mental deficiency .... 




2 


2 




2 


2 








21. 


Undiagnosed psychoses .... 


9 


9 


18 


7 


9 


16 


2 - 


2 




22. 


Without psychosis 




1 


1 




1 


1 










Total 


92 


74 


166 j 88 

1 


72 


160 


4 1 


5 


1 1 



Table 11. Economic Conditions of First Admissions Classified ivith Reference to 

Principal Psychoses. 



Psychoses 




Tota 


1 


Dependent 


Marginal 


Unascertained 






M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


1. 


Traumatic 


2 




2 








2 




2 




2. 


Senile 






















3. 


With cerebral arteriosclerosis 


1 




1 








1 




1 




4. 


General paralysis 


41 


1 


42 


1 




1 


40 


1 


41 




S. 


With ceiebral syphilis 




2 


2 




1 


1 




1 


1 




6. 


With Huntington's chorea .... 






















7. 


With brain tumor 




2 


2 










2 


2 




8. 


With other brain or nervous diseases 


1 


4 


5 




1 


1 


I 


3 


4 




Q. 


Alcoholic 


5 




S 








5 




5 




10. 


Due to drugs and other exogenous toxins 


5 


2 


7 








5 


2 


7 




11. 


With pellagra 






















12. 


With other somatic diseases. 


1 


13 


14 




1 


1 


1 


11 


12 


1 1 


13. 


Manic-depressive 


7 


14 


21 




1 


1 


7 


13 


20 




14. 


Involution melancholia 


1 


4 


5 








1 


4 


5 




15. 




18 


14 


32 


1 




1 


17 


14 


31 




16. 


Paranoia and paranoid conditions 


1 


4 


5 








1 


4 


5 




17. 
























18. 


Psychoneuroses and neuroses 




1 


1 










1 


1 




19. 


With psychopathic personality 




1 


1 










1 


1 




20. 


With mental deficiency 




2 


2 




1 


1 




1 


1 




21. 


Undiagnosed psychoses .... 


9 


9 


18 








9 


9 


18 




22. 


Without psychosis 




1 


1 










1 


1 






Total 


92 


74 


166 


2 


5 


7 


90 


68 


158 


1 1 



52 



P.D. 13 



Table 12. Use of Alcohol by First Admissions Classified with Referecne to 

Principal Psychoses 



Psychoses 




Total 


Abstinent 


Temperate 


Intemperate 


L nascertame 


— 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. Traumatic .... 


2 




2 


1 


- 


1 


- 


- 


- 


1 


- 


1 


- 


- 


- 


2. Senile 
































3. With cerebral arteriosclerosis 


1 




1 


- 


- 


- 


- 


- 


- 


1 


- 


1 


- 


- 


- 


4. General paralysis. 


41 


1 


42 


15 


— 


15 


19 


1 


20 


6 


— 


6 


1 


- 


1 


5. With cerebral syphilis 


- 


2 


2 


- 


1 


1 


- 


1 


1 














6. With Huntington's chorea. 
































7. With brain tumor 


- 


2 


2 


— 


2 


2 




















8. With other brain or nervous 
































diseases .... 


1 


4 


5 




4 


4 














1 


— 


1 


9. Alcoholic .... 


5 


' 


5 






~ 


- 


- 




5 


- 


5 


- 


- 


- 


10. Due to drugs and other ex- 
































ogenous toxins. 


5 


2 


7 


1 




1 


1 


2 


3 


3 




3 


- 


— 


- 


11. With pellagra 
































12. With other somatic diseases 


1 


13 


14 


1 


13 


14 




















13. Manic-depressive. 


7 


14 


21 


3 


12 


15 


2 


1 


3 


2 




2 




1 


1 


14. Involution melancholia 


1 


4 


5 




4 


4 


1 




1 














15. Dementia praecox 


18 


14 


32 


12 


12 


24 


4 


1 


5 


2 


1 


3 


- 






16. Paranoia and paranoid con- 
































ditions .... 


1 


4 


5 


1 


4 


5 




















17. Epileptic psychoses 
































18. Psychoneuroses and neuroses 




1 


1 




1 


1 




















19. With psychopathic person- 
































ality 


1 




1 




1 


1 




















20. With mental deficiency 




2 


2 




2 


2 




















21. Undiagnosed psychoses 


9 


9 


18 


8 


7 


15 




2 


2 


1 




1 








22. Without psychosis 




1 


1 




1 


1 




















Total .... 


92 


74 


166 


42 


64 


106 


27 


8 


35 


21 


1 


22 


2 


1 


3 



Table 13. Marital Condition of First Admissions Classified with Reference to 
Principal Psychoses. 



Psychoses 




Total 


Single 


Married 


Widowed 


Separated 


Divorced 




M. 


F. 


T. 


U. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


1. Traumatic . 


2 




2 


2 




2 
















2. Senile .... 




























3. With cerebral arterio- 




























sclerosis 


1 




1 








1 




1- 










4. General paralysis 


41 


1 


42 


20 




20 


19 




19 


1 


- 1 


- 1 1 


1 - 1 


5. With cerebral syphilis 




2 


2 










2 


2 










6. With Huntington's cho- 




























rea .... 




























7. With brain tumor 




2 


2 
















2 2 






8. With other brain or 




























nervous diseases 


1 


4 


5 




1 


1 


1 


2 


3 




1 1 






9. Alcoholic 


5 




5 


1 




1 


4 




4 










10. Due to dru.qs and other 




























exogenous toxins 


5 


2 


7 


3 




3 


2 


2 


4 










11. With pellagra 




























12. With other somatic 




























diseases . 


1 


13 


14 




1 


1 




12 


12 


1 


- 1 






13. Manic-depressive 


7 


14 


21 


5 


10 


15 


2 


4 


6 










14. Involution melancholia 


1 


4 


5 


1 


2 


3 




1 


1 




1 1 






15. Dementia praecox 


18 


14 


32 


14 


11 


25 


4 


2 


6 








- 1 1 


16. Paranoia and paranoid 


1 






















- 1 1 




conditions 


4 


5 


1 


1 


2 




2 


2 








17. Epileptic psychoses . 




























18. Psychoneuroses and 




1 






1 


1 




1 












neuroses . 




1 
















19. With psychopathic per- 






1 




1 


1 
















sonality 




1 


















20. With mental deficiency 




2 


2 




2 


2 
















21, Undiagnosed psychoses 


9 


9 


18 


7 


5 


12 


2 


4 


6 










22. Without psychosis 




1 


1 










1 


1 










Total . 


92 


74 


166 


54 


35 


89 


35 


32 


67 


2 


4 6 


- 2 2 


1 1 2 



P.D. 137 



53 



Table 14. Psychoses of Readmissions. 

Psychoses Males Females Total 

General paralysis - 1 1 

Psychoses clue to drugs and other exogenous toxins - 1 1 

Manic-depressive psychoses 1 5 6 

Dementia praecox 1 4 5 

Hsychoneu roses - 1 1 

Undiagnosed psychoses - 3 3 

Total 2 15 17 

Table 15. Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge. 



Psychoses 



Traumatic 

Senile 

With cerebral arteriosclerosis 

General paralysis 

With cerebral syphilis . . . . 
\vith Huntington's chorea . . . . 

With brain tumor 

W:th other brain or nervous diseases 

Alcoholic 

Due to drugs and other exogenous toxins 

With pellagra 

With other somatic diseases 

Manic-depressive 

Involution melancholia . . . . 

Dementia praecox 

Paranoia and paranoid conditions 

Epileptic psychoses 

Psychoneu roses and neuroses 

With psychopathic personality . 

With mental deficiency .... 

Undiagnosed psychoses .... 

Without psychosis 

Total 



Total 



M. 



17 23 40 



T. 



Recovered 



M. F. T. 



1 - 1 

-22 



2 2 



Improved Unimproved 



M. F. T. 



-33 
1 3 4 



15 18 33 



M. 



1 1 



1 1 



Fable 16. Causes of Death of Patients Classified with Reference to Principal 

Psychoses. 



Causes of De.\th 



Epidemic, Endemic and Infectious 
Diseases 
Purulent infection, septicaemia. 
Jeneral Diseases not Included in Class I 
Tancer and other malignant tumors . 

Diseases of the Nervous System 
general paralysis of the insane . 
Hher diseases of the nervous system . 

Diseases of the Circulatory System 
\rteriosclerosis 

Diseases of the Respiratory System 
Bronchopneumonia .... 

Diseases of the Digestive System 
Other di.seases of digestive system 

(cancer and tuberculosis excepted) 

Non-Venereal Diseases of Genito- 
urinary System and Annexa 

Nephritis 

Other diseases of kidneys and annexa 

Total 



Total 



6 7 13 1 



With 
cerebral 
arterio- 
sclerosis 



M. F. T. 



General 
paralysis 



M. F. T. 



3-3 



Alcoholic 



M. F. T. 



1 - 1 



Manic- 
depressive 



M. F. T. 



lAll other 
psychoses 



M. F. T. 



1 1 
1 1 



1 1 

2 2 



1-1 - 7 7 



'Includes Group 22, "without psychosis". 



54 



P.D. 13 



O 

5S5 



0^ 



6 i> 



3 .-o 



— ^ O 4-> ~ ■ 
O p G O 

x: 



2 «= 
t: o 

C toT3 ,, 0_2 

X 2 ^ S -p o o .2? 



ix3 >. 



c. 

G 3 u t; 55 a. 



P.D 137 



55 



Table 18. Total Duration of Hospital Life of Patients Dying in Hospital 
Classified According to Principal Psychoses. 











Less than 


1-3 


1 4-7 


8-12 


1-2 


Psychoses 




Tot 


al 


months 


months 


months 


months 


years 




M. 


F. 


T. 


Vf 


r . 


T 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


1. Traumatic 






















2. Senile 






















3. With cerebral arteriosclerosis 


1 


- 


1 


1 




1 










4. General paralysis 


3 


- 


3 


3 




3 










5. With cerebral syphilis 






















6. With Huntington's chorea . 






















7. With brain tumor 


- 


2 


2 




1 


1 


- 1 1 


- - - 


- - - 


- - - 


8. With other brain or nervous dis- 






















eases 


- 


1 


1 








- 1 1 










1 


- 


1 


1 




1 










0. Due to drugs and other exogenous 






















toxins 






















1. With pellagra .... 






















2. With other somatic diseases 


— 


3 


3 


- 


2 


2 


— — - 


- 1 1 


— — — 


— — — 


3. Manic-depressive 


1 


- 


1 














1 - 1 


4. Involution melancholia 






















5. Dementia praecox 






















6. Paranoia and paranoid conditions 






















7. Epileptic psychoses 






















8. Psychoneuroses and neuroses 






















9. With psychopathic personality . 






















0. With mental deficiency 






















1. Undiagnosed psychoses 




1 


1 








- 1 1 








2. Without psychosis 






















Total 


6 


7 


13 


5 


3 


8 


-33 


- 1 1 




1 - 1 



r 

Public Document 



No. 137 



ANNUAL REPORT 



TRUSTEES 

OF THE 

Boston Psychopathic Hospital 

FOR THE 

Year Ending November 30^ 1931 

1931 

Department of Mental Diseases 



1 HLICATION OK THIS DOCimsr^ APPROVED BY THE COMMISSION ON ADMINISTRATION AND FINANCE 

650 — 5 32. Order 5235. 



OCCUPATIONAL PHINTINO FLANT 
DEPARTMENT OF MENTAL OISCASES 
OARONCn aTATK COLONY 
OARONBN. MASS. 



BOARD OF TRUSTEES 
William Healy, M.D., Chairman, Boston. 
Mrs. Esther M. Andrew s, Secretary, Brookline. 
Carrie I. Felch, M.D., Boston. 
Channing Frothingham, M.D., Boston. 
Allan W. Rowe, Ph.D., Boston. 
William J. Sullivan, Boston. 

Charles F. Rowley, Boston. I 

CONSULTING PHYSICIANS 
E. B. Goodall, M.D., Ophthalmologist. 

G. Philip Grabfield, M.D., Internist. . 
Leon E. White, M.D., Oto-Laryngologist. 
Abraham Myerson, M.D., Neurolo(,ist. 

E. B. Sheehan, M.D., Gynecologist. ' 
JoHjf Rock, M.D., Obstetrician. : 
J. H. SwARTZ, M.D., Dermatologsit. I 

The staffs of adjoining hospitals. 

OFFICERS OF THE HOSPITAL 
C. Macfie Campbell, M.D., Medical Director. 

Arthur N. Ball, M.D., Chief Executive Officer. ' 
Karl M. Bowman, M.D., Chief Medical Officer. 
Paul C. Dozier, M.D., Senior Physician. 

G. Philip Grabfield, M.D., Senior Physician. ■ 

John P. Powers, M.D., Senior Physician. 

Oscar J. Raeder, M.D., Senior Physician. 

Harry C. Solomon, M.D., Senior Physician. 

Robert E. Britt, M.D., Assistant Physician. 

Wilfred Bloomberg, M.D., Assistant Physician. 

Margaret E. Hatfield, M.D., Assistant Physician. 

Merrill Moore, M.D., Assistant Physician. 

Mary Palmer, M.D., Assistant Physician. 

Charles B. Sullivan, M.D., Assistant Physician. , 
William L. Valens, M.D., Assistant Physician. i 
Burton W. Adams, M.D., Medical Interne. 
Clarence D. Hart, M.D., Medical Interne. 
Edgervon M. Howard, M.D., Medical Interne. 

Douql.^s R. MacCalman, M.D., Medical Interne. ■ 

, Chief of Neuropathological Laboratory. \ 

Mariohie Fulstow, M.D., Acting Chief of Neuropathological Laboratory^ \ 
Whitman K. Coffin, M.D., Roentgenologist. 

Peter J. Dalton, D.M.D., Dentist. \ 

F. L. Wells, Ph.D., Head Psychologist. 

Mary Fitzgerald, Principal of School of Nursing. 

Esther C. Cook, Head Social Worker. 

E.THELWYN F. Humphrey, Head Occupational Therapist. 

Mrs. Elveretta Blake, Librarian. 

Elizabeth Libber Shore, Treasurer. 

iBy arrangement with the Department of Mental Diseases 



CONTENTS 

Report of Trvsteos 3 

Report of Medical Director 3 

Reoort of Out-Patient Department 15 

Fveport of Chief Medical Officer 19 

Report of Biochemical Laboratory 22 

Report of Psychological Laboratory 22 

Report of Neuropathological Laboratory 24 

Report of Department of Therapeutic Research 24 

Report of Chief Executive Officer 27 

Report of Social Service Department 28 

Report of Superintendent of Nurses 33 

Report of Department of Occupational Therapy 34 



f 

p.. >. 137 



3 



REPORT OF THE TRUSTEES OF THE BOSTON PSYCHOPATHIC 

HOSPITAL 

To His Excellency Ihe Governor and the Hotiorable Council: 

We have the honor of presenting this admirable and highly interesting report 
from the officers of the Boston Psychopathic Hospital for the year 1931. The 
modesty of the statement of the many important activities bespeaks the highly 
scientific spirit in which they are carried on. The ordinary nu^-sing and housing of 
mental patients is always, of course, of prime importance, but the study and re- 
search aspects of psychiatry as carried on in this hospital are of still deeper signifi- 
cance for the treatment of individual patients. Moreover, it is only through the 
continuous development of research methods that we shall ever be making any 
headway towards prevention of the terrible scourge of mental disease. What is 
aimed at and what is actually being accomplished is a thrilling story to anyone 
acquainted with this field and we are ever proud of the part which our hospital is 
playing and of the support by the Commonwealth of these highly fundamental 
and most practical ventures. The study of bodily conditions, of the mental life 
itself, and of the social factors and implications in these cases of mental disease 
are seen in this report to be closely interrelated and each to receive as thorough 
consideration as is possible with the personnel available. 

That this hospital has been able to maintain such high standards in its personnel 
is a matter for congratulation and is due in no small part to the attitude of the 
Director and the Chief Medical Officer, Dr. Bowman. Many departments show 
highly commendable activities but once more we would call attention to the enor- 
mously important activities of the department of therapeutic research and to the 
extensive restoration of patients suffering from desperate mental conditions which 
is accomplished by Dr. Solomon and his co-workers. 

In the light of frequent inquiries we note with much interest that the admission 
rate has not shown any special increase during the ten years of the existence of 
the hospital as a separate entity — a fact that has some bearing on the problem of 
whether mental disease is growing in quantity under the conditions of modern 
living. Then, too, the fact that during the present economic depression there has 
been no increase whatever, as is commented on in this report, is another point for 
those who question the relationship between social conditions and mental break- 
down. 

It is perfectly true that various departments feel themselves greatly cramped 
and that better work could be done if there were more professional people attached 
to the hospital. However, we can but feel highly gratified at the amount of work 
carried on as well as its high quality. The many pages of the report which prove 
this are worth careful perusal. This short introduction can serve no better purpose 
than to call attention to what is herein reported. 

We express again this year our gratitude for the excellent service which has been 
rendered on every side by the Director, Dr. Campbell, the Executive Officer, Dr. 
Ball, who has just left us, and by the entire staff. Our monthly visits have brought 
forth practically no complaints and on every hand we have had many evidences 
of really splendid achievement. 

Respectfully submitted, 
WiLLiA-M Healy, Chairman. Carrie I. Felch 

Esther M. Andrews, Secretary Charles F. Rowley 

William J. Sullhan Chanmnq Frothinoham 

Allan W. Rowk. Trusteat. 



MEDICAL DIRECTOR'S REPORT 
To the Board of Trustees of the Boston Psychopathic Hospital: 

In accordance with the provision of the statutes I submit for your consideration 
the report for the statistical year ending September 30, 1931 and for the fiscal year 
ending November 30, 1931. 



4 



P.D. is:] 



General Considerations on the Work of the Hospital 



In the annual report of a hospital one expects to find a concise summary of thd 
work done, with a systematic presentation of tables and figures. These tables give' 
the specific nature and the extent of the work done in various departments, and tC' 
one who is at first hand familiar with the work of a hospital they may give ar 
accurate picture of its activity and may tell an elocfuent story. There are many 
however, who have little knowledge at first hand of the work of a hospital and tc^ 
whom the nature of the problems dealt with at a psychopathic hospital is totallj' 
unfamiliar. The technical medical terms used in the tables of diagnosis majf 
convey little meaning, and the reader may have no idea that in the technical term 
"schizophrenia" there lies concealed a human drama of interest, involving some* 
of the fundamental issues of life. The conflict within the individual between in- 
stinctive and moral factors, the struggle of the individual to attain adult inde-t 
pendence and to get satisfaction for his varied needs from the sources available to 
him in the environment, do not stand out clearly in formal statistical tables; the 
mere number of patients admitted gives no indication of the time and effort which 
is required to deal with the varied problems of the different types of mental disorder. 
The report of a psychopathic hospital is not only a report of the number of patients 
treated, and of the disorders from which they suffer, it is an attempt to present 
the activity of the hospital as a whole in its intimate connection with the life of the- 
community. The work of the general hospital is of great importance to the com- 
munity; it deals with acute and serious forms of illness, promotes the study of the! 
cause and cure of disease, and helps to educate the community in problems of 
health. The work of the psychopathic hospital reaches still more deeply into the ' 
personal life of the individual, into the home, the schoolroom and the workroom, | 
and should contribute to the knowledge of mental health and to practical measures j 
for preventing shipwreck and for salvaging the disabled. ^ 

The greatest variety of patients are brought to the Boston Psychopathic Hospital. 
The patients present problems not as a rule dealt with by the general hospitals, 
which focus upon the health of the component systems or organs but do not accept ' 
patients whose primary disorder seems to involve the personality as a whole. In ! 
the patjents of the Boston Psychopathic Hospital the disorder of the personality { 
is in the centre of attention, whether that disorder express itself in physical com- 1 
plaints, in disordered behaviour or in a morbid attitude towards life. 

Many patients come to the Boston Psychopathic Hospital on account of diffi- 
culties of which they themselves are aware. They are suffering from some mental 
distress, they are aware of some disturbance in their personality, they are perplexed 
by the way in which the world appears to them, they realize that their attitude 
towards their fellows is disturbed. In some cases the complaint is not primarily 
of a disturbance of the more complex functions of mood and outlook but of physical 
symptoms, of headache, sleeplessness, palpitation, faintness, uncomfortable feelings 
of one kind or another, based upon some obscure disturbance of the instinctive and 
emotional life. In other cases the patient realizes no personal difficulty or disorder 
but is brought because, owing to his behaviour or his outlook on life, he is considered 
sick by others. Looking through his troubled medium the patient sees a world 
which is full of strange and disturbing forces, of hostility and suspicion and criti- 
cism, and he sees forces at work of which previously he would have denied the 
existence. 

Other patients are brought to the hospital on account of social conduct which is 
disturbing and which in the past has usually been dealt with by disciplinary 
measures. Many adult patients are sent by the court on account of disturbance 
either in the home or outside of the home. The problem may be one of theft or 
other fraudulent behaviour, of episodes of violence or of sexual misconduct, or it 
may be a question of marital incompatibility. It is becoming more frequent to 
postpone disciplinary measures until there has first been made a thorough study of 
the behaviour and outlook of the individual in the same way in which one studies 
the behaviour and outlook of a person who is mentally sick. 

Many children are brought to the clinic on account of problems presented in 
the schoolroom, the problem being either lack of academic progress or disturbing 
behaviour of various types. 



P.D. 137 



5 



The role of the hospital in such a case is to act as expert adviser and to put at 
the disposal of the parent, the school or the court whatever insight into the under- 
lying factors has been gained, so that the home, the school, the court can deal in 
a more intelligent way with its own special problems. 

The primary role of the hospital is the study and care of the patients referred 
to it, but the hospital has also the responsibility for carrying on scientific investi- 
gation into the causes of mental disorders and into the treatment of them. In 
addition, it serves as a school of instruction for various types of students including 
medical students, medical graduates, psychologists, nurses, occupational therapists, 
social workers and laboratory technicians. 

Ox Some of the Problems Presented by the Patients 
In previous reports it has been felt advisable to give some concrete examples of 
the exact problems presented by the patients admitted to the hospital and in 
different years examples have been taken from different groups of mental disorder. 
Attention in past reports has been paid to mental disorders which occur in the 
setting of bodily sickness, to delinquency as the result of organic brain disease, to 
conditions of depression elicited by specially trying circumstances. 

In connection with this last topic, the question has arisen whether the present 
economic difficulties, already of considerable duration, have not had a considerable 
effect in precipitating mental disorder. As a matter of fact, the staff of the hospital 
have considered this subject and find little evidence in their own hospital patients 
to indicate a period of special economic strain. During the past year, as in previous 
years, patients have been admitted with pronounced depression coming on after 
prolonged unemployment or financial losses, but cases of this type seem to have 
been no more frequent during the past year than during previous years. 

The question of the causation of mental disorders in the individual case is always 
a most complex one. It is only in the simpler situations such as the delirium of 
typhoid fever or the dementia of brain tumor that mental disorder can be attributed 
to a single cause. In most cases the mental disorder is to be understood as the 
reaction of a special individual with his own life history to the special stresses to 
which he is subject. Constitutional endowment, early moulding influences, un- 
digested and repressed experiences, intercurrent physical disorders, unhappy 
situations of prolonged or acute nature all contribute to the development of the 
mental disorder. Where a mental disorder follows upon economic difficulties, 
either acute or chronic, one must hesitate to lay all the stress upon the economic 
difficulty and must give due weight to the factors which determine the way in 
which the individual reacts to such strains. Economic stress may be wide-spread 
without there being much increase of mental disorder if the community as a whole 
has a certain degree of resistance and adaptability. The fact that an economic 
situation is general may have something to do with its comparative innocuousness, 
for a discomfort or a trial borne in common, with no concealment or repression, is 
a different matter from a trial to which one is exposed as an isolated individual, 
which differentiates the individual from his neighbors, which is concealed from 
others and repressed from one's own consciousness. 

On Chronic Alcoholism as a Cause of Mental Disorder and as a Social 

Problem 

Among the patients admitted to the hospital are many whose mental disorder 
is largely due to chronic alcoholism. Such cases present for medical study many 
interesting problems, partly at the physiological level, partly at the psychological 
level. The underlying nutritional and toxic factors in delirium tremens are still 
quite obscure. The psychological factors which have determined the addiction to 
the use of alcohol deserve careful scrutiny in each case. The social factors involved 
in the problem are matters of general interest and of wide discussion. 

The following cases illustrate the complicated personal and social issues pre- 
sented by patients with mental symptoms due to chronic alcoholism. 

A.B., aged 37, a railway worker, had been brought before the court on account 
of non-support of his wife and child. He was referred by the court to the hospital 
on account of his queer behaviour and unintelligent answers in court. On admission 
he was found to present a great variety of nervous symptoms due to chronic 



6 



P.D. 137 



poisoning. His speech was slurring, he walked unsteadily, there was weakness oJ 
the external ocular muscles. In addition, the mental functions were involved. He 
thought that the hospital was a private house and that the month was June 
(October), and was unable to grasp the meaning of the situation. The patient was! 
transferred to a state hospital for continued treatment. 

The memory of this patient was damaged perhaps permanently, and it was \ 
possible that he would be unable to resume his place in the community. The con- 
dition was the later stage of a life which had already been punctuated by many, 
arrests for drunkenness. He had been a danger to the community from driving an 1 
automobile under the influence of liquor. J 

B.C., aged 38, a married woman, had become noisy and unmanageable while 
in jail where she had been sent on account of intoxication. The patient showed a; 
rather superficial and flippant attitude, was not at all confused, reviewed her 
history with the examiner, seemed to have good insight into the whole situation. 1 1 
The disturbing behaviour in the jail had apparently been of a quite temporary ; 
nature. This patient had been in a reform school during adolescence. Since then ! 
she had spent about 12 years of her life in penal institutions, chiefly on account 
of her drinking habit. She had married at the age of 28 but was deserted by her 
husband at the end of one year. Her drinking episodes were usually in company 
with other women. In this case one sees an individual of somewhat poor endow- ;i 
ment, with inefficient home upbringing who, after a certain period in a reform ^^i 
school, had drifted along in life in a haphazard and stumbling way and had come J 
many times to the attention of the social authorities and received jail sentences j j 
without any constructive work being done. ]' 

CD., a married woman of 38. Even before 20 she had been accustomed to go ' 
on drinking sprees, and she continued this habit after marriage. During the acute p 
episodes she behaved in a very irresponsible manner. Previous to her admission I' 
she had been very excited and incoherent, suspicious of those around her, had 
hallucinations. 

The patient cleared up soon after admission but she was unwilling to stay in the 
hospital in order that her problems might be thoroughly studied, and was taken \ 
out by her husband against the advice of the physicians. ; 

D. E., a divorced woman of 32, was admitted in a somewhat excited con- | 
dition two weeks after she had been discharged from a state hospital. She had ] 
already three times during the year suffered from acute mental disorder based upon 
her alcoholic habits. Five years previously she had already had a record of twenty , ; 
arrests for alcoholism or for misdemeanors connected with alcoholism. She was ' 
probably immoral, quite incompetent to care for her three children, and her original ' 
mental endowment was very meagre. 

The acute symptoms soon cleared up and the patient discussed her situation in 
a clear way, referring to her good intentions and plans for the future as she had 
always done on previous occasions before leaving the hospital. 

The poor original endowment of this woman and the actual history of her ex- I 
periences were a sufficient indication of what her later career would be, unless 
strictly supervised. Such a case presents a very difficult problem from the point 
of view of institutional management. To afford adequate institutional facilities 
for not only the supervision but the appropriate occupation and treatment of such 
a patient may seem expensive, but against this expense has to be balanced the 
inevitable expense of a prolonged series of social misdemeanors with wide reaching 
consequences and the expense of police and court procedures. 

E. F., aged 57, was brought to the hospital after a violent altercation with his 
wife. For many years there had been much marital friction and on one occasion 
he had attempted suicide. He had been drinking illicit liquor manufactured by ; 
his wife and his eyesight had been impaired by this. In addition to the mild j 
impairment of his eyesight and the acute altercation previous to admission, the 
patient showed a mild degree of mental confusion. 

In this case the alcoholism seemed to be more or less incidental to a difficult 
marital situation. 

F. G., aged 40, was transferred to the Boston Psychopathic Hospital from the ; 
Boston City Hospital in a state of great excitement. He had been taken to tha 



P.D. 137 7 

Boston City Hospital in a comatose condition. On admission to the Boston Psy- 
chopathic Hospital he showed marked motor disorder, was in a condition of delirium ; 
after nine days in hospital he was able to return home. 

In this case no detailed study was made of the extent of the patient's drinking 
or of the psychological factors which had led to it. 

G. H., aged 37, after a heavy drinking bout at a convention became afraid, 
suspicious and heard voices. The patient throughout his whole life had been some- 
what eccentric and there had been increasing lack of compatibility with his wife, 
with episodes of friction and of gross behaviour on his part. 

The drinking, with the acute exacerbation, was only one phase in an ill-balanced 
and difficult life, but the alcoholism had been the major factor in precipitating the 
mental disorder. 

H. I., aged 44, a housewife, for 14 days had been drinking to excess and had been 
extremely jealous of her husband, making public accusations of infidelity and 
causing disturbing scenes. She said that she was more of a man than a woman; 
she disliked women unless they would drink with her. Before admission to the 
hospital she had been hearing imaginary voices, threatened to kill her husband, 
claimed that she had miraculous power. 

I. J., aged 46, a longshoreman. The patient, an affectionate and kindly father 
i of a family, a favorite in the community, had for a considerable period been in- 
dulging periodically in prolonged alcoholic sprees, associated with violent behaviour. 
In one of these attacks he was brought into the Boston Psychopathic Hospital. 
A few days after admission he was quite clear and apparently in his normal con- 
dition. The examination of the patient could only be made through an interpreter 
so that no detailed review of the psychology of the case was possible. 

J.K., aged 48, a divorced woman, had for years been indulging intermittently in 
alcohol. She had married at 19 but was deserted in a few years when she had one 
child. Throughout her life she had shown a marked tendency to depression and 
the alcoholism may have been largely determined by the depression. For some 
time before admission she had also indulged in veronal. The picture in the hospital 
was that of a rather depressed woman, somewhat discouraged with the record of 
her life. She attributed the beginning of her alcoholism to working as a govern- 
ment employee in a situation where there was too much liquor around. In this 
case the chronic alcoholism had to be considered in the light of the constitutional 
endowment, the tragic marital situation, the temptations of the social environment. 

The review of the cases of mental disorder due to alcoholism, who have passed 
through the hospital, is a somewhat discouraging experience. In many cases the 
hospital is only acting as adviser to the court. In other cases the hospital merely 
helps the family of the individual in an emergency, while after the emergency the 
family is content to resume the previous condition and the patient himself considers 
the whole episode disposed of without any further analysis of the underlying roots 
of the disorder. The physician is in the discouraging situation in many cases of 
merely observing and recording a transitory episode in a rather tragic life history, 
without having either the opportunity to make a thorough study of the case or 
the authority to deal with the situation. It is apparent, even from a casual review 
of the above brief histories, what an important role social factors play in the pre- 
vention and in the management of such disorders. 

Patients are referred from the courts for various causes and the following cases 
illustrate the type of assistance which the hospital can furnish to the court. 

K.L. was brought before the court on the charge of being a stubborn child by 
his mother who was probably untruthful and of dubious character. She wanted 
him placed in an industrial school but the court referred the boy to the hospital 
for a complete study. The boy was found to be of average intelligence and of fairly 
stable endowment and quite capable of taking advantage of better home conditions. 
It was recommended, tlierefore, that he be sent to a foster home where he had 
already spent some time and where the foster mother was genuinely interested in 
his welfare. 

L.M., aged 14, a schoolboy, was referred by the court on the urgent appeal of 
the family physician. The boy had been brought to court on account of stealing 
automobiles, but the family physician had realized a certain oddity in the previous 



8 



p.D. 13'; 



behaviour of the boy. The hospital examination revealed the presence of som« 
organic nervous disorder, probably a brain tumor, and the boy was referred t( 
another clinic for surgical study. , 

M.N., aged 28, a colored woman, was brought into court on account of intoxi 1 
cation. She was found to have a well marked mental disorder and the intoxicatior:, 
was only an incidental episode. An employer of the patient, who was well aware 
of the nature of the mental disorder, was willing to take the patient back into hei 
employ and give her adequate supervision. 

N.O., aged 30, of no occupation, was brought into court on account of drunken- 
ness which, however, had been preceded by a violent outbreak. For many years 
he had been subject to epilepsy and there was a history of a head injury. Since 
the age of 15 there were at least 40 police records, most of which were for drunken- 
ness. In this case the responsibility for the supervision of the situation was with 
the Veterans Bureau. 

O.P., aged 14, a schoolboy, was referred by the court where he had been brought 
on the charge of bein^ a stubborn child. The main indication of this was that he 
had frequently run away from home. The study of the child showed that he was 
a boy of rather superior intelligence in an extremely bad home situation to which 
the running away was a quite healthy reaction. Arrangements were made to have 
him under the care of a child-placing agency while he was also referred to a neigh- 
boring hospital for treatment of a special blood disease. 

The general run of patients who come to the hospital can be grouped into (a 
those whose symptoms are caused by some damage to the central nervous system 
or by some general somatic disorder and (b) those whose symptoms form part of 
an unsuccessful adaptation of the individual to the problems of his cultural en- 
vironment. 

In the study of those cases where there is an underlying somatic disorder technical 
equipment similar to that of a general hospital is required. The physicians have 
to treat cases of mental disorder following chidlbirth or accompanying a great 
variety of febrile disorders, patients who have suffered head injuries or other 
injuries sometimes self-inflicted, various forms of heart disease and respiratory 
infections, gastro-intestinal disorders, pernicious anemia, polyneuritis, diabetes, 
endocrine disorders, the more familiar forms of organic damage to the brain such 
as general paralysis, encephalitis, cerebral arteriosclerosis, tumor, meningitis, cere- 
bral hemorrhage. In the treatment of such varied conditions the staff is fortunately 
able to call on a group of consultants whose generosity in responding to the demands 
made on them it is a pleasure to acknowledge here. 

In the study of those cases where the problem is that of an unsuccessful adapta- 
tion to the wider issues of life the physical status of the patient has to be inves- 
tigated, but the major task is the detailed and systematic analysis of the personality 
and a careful review of the actual life situation, with its special significance for the 
patient. It is only in a limited number of cases that the conditions are present for 
a detailed review of the personality. The mental disorder itself may prevent the 
cooperation of the patient, or the patient may not be willing to accept the suggestion 
of the physician that such a psychological analysis be undertaken. In some cases 
the level of intelligence is not favorable for such an analysis. In other cases there 
may be language difficulties, while administrative factors sometimes make it im- 
possible to keep the patient in the hospital during the period required. The time 
consumed in a thorough review of the personality is very great and it is only in a 
small number of patients that the procedure can be carried out to the extent 
desired. The procedure is, however, more than a mere method of study. It is of 
the greatest value to the individual patient, making much clearer to him the forces 
which underlie his behaviour and attitude and bringing them more directly under 
the influence of his own conscious direction. The insight into the underlying 
mechanisms of the personality derived from the intensive study of a small number 
of cases is of the greatest value in the interpretation of the symptoms and the 
treatment of other cases where no such complete analysis is possible. These \ 
studies which are so important for the treatment of the individual patient contribute ■ 
valuable information to knowledge of the normal personality and are of cardinal ' 
importance for any thorough study of domestic and wider social relations. 



P.D. 137 



9 



On Treatment 

In a number of cases the patients come to the hospital merely for diagnosis, but 
a considerable number come not only for diagnosis but for treatment. In some 
cases, especially those of acute onset and of more benign nature, the patient may 
be treated in the hospital until convalescent and able to return home. In other 
cases where the treatment promises to be a matter of very long duration the patient 
may sooner or later be transferred to a state hospital for continued treatment-. 

The treatment of mental disorders may be roughly divided into special pro- 
cedures for specific underlying somatic disturbances and into more general proce- 
dures directed to the reestablishment of the psychological equilibrium and of the 
adaptation of the patient to the social group. 

With regard to special therapeutic procedures, Dr. Solomon in his report dis- 
cusses briefly the treatment of neurosyphilis, of epilepsy and of stuporous con- 
ditions. 

The general treatment of the patient in whom no specific somatic ailment is 
present is a complicated activity, which does not stand out in bold relief as a 
separate factor but which permeates the whole of the life of the wards. Students 
are apt to think that there is little treatment being carried on in the wards because 
the familiar apparatus for the treatment of medical and surgical cases is compara- 
tively little in evidence. They may not at first realize, any more than the casual 
visitor, how important for the treatment of the individual case are not only re- 
moval from the ordinary social and economic responsibilities of the everyday en- 
vironment and adaptation to the hospital routine, but also the repeated interviews 
with the physician, the contact with the nurses, the atmosphere of the department 
of occupational therapy. 

The organization of the nursing service, with the large number of affiliated 
nurses from other hospitals who spend three months at the Boston Psychopathic 
Hospital, proves to be very satisfactory. The frequent change of personnel may 
have some drawbacks, but the influx of eager and interested workers has a decidedly 
stimulating effect. The new workers soon absorb the point of view of the staff 
and return to their general hospital with a much broader outlook on the field of 
nursing in general. 

During the past year the occupational therapy department lost Miss Humphrey 
as its guiding spirit. Miss Humphrey had for nine years directed this department 
in a quiet, efficient, thoughtful and progressive way and had on more than one 
occasion published articles dealing with her specialty. The hospital owes a debt 
of gratitude to Miss Humphrey, and her successor. Miss Waite, in taking charge 
of the department found a tradition of technical accomplishment and of personal 
devotion which is a great asset; Miss Waite comes to the work well prepared by 
her previous training, and is no stranger to the hospital having worked there as 
assistant in the department of occupational therapy from 1921 to 1925. 

On the Social Service Department 
In a small proportion of the patients of the Boston Psychopathic Hospital the 
disordered behaviour or morbid attitude is merely symptomatic of some under- 
lying impersonal process interfering with the normal working of the brain, and in 
these cases the attention of the physician is focussed upon the underlying bodily 
disorder and on the specific methods of treatment indicated. In a larger number 
of cases the mental symptoms can only be understood as part of a process whereby 
the patient unsuccessfully attempts consciously or unconsciously to adapt himself 
to certain situations of the social environment or within his own personality. As 
has been stated above the clinical picture cannot be understood unless one under- 
stands the forces which make the patient what he is and unless one understands the 
situation to which he has to react. The study of the patient means a study of his 
original endowment and of the past experiences which have helped to mould the 
personality. 

The aim of the physician in such a case is not to combat an impersonal disease 
process but to help a human being with his complex organization to adapt himself 
in a better or more socially acceptable way to the conditions of social life. 



10 



P.b. 137 



It is not often possible for the physician, unaided, to make an accurate study of 
the external forces which have moulded the patient nor of the environment with 
the complicated social values involved. In assisting the patient to regain his 
equilibrium it may be important not only to help the patient to deal better with 
personal factors for which he is responsible, but also to modify the situation so 
that the patient will be exposed to less stress. 

In both these tasks of study and of treatment the psychiatric social worker is 
invaluable. She enables the physician to understand much more clearly the de- 
velopment of the disorder, and she is able to translate into practical terms many 
of the general recommendations of the physician. The co-operation of the social 
service department with the clinical staff of the hospital on the one hand, and with 
many social organizations of the community on the other hand is essential for the 
satisfactory functioning of the hospital. During the past year the work of the 
department has continued to be of the same high level as in previous years and the 
effort has been made to make the cooperation with community agencies as close 
as possible. In the Friday morning conferences of the out-patient department 
the psychiatric social worker plays an important role and maintains an increasingly 
intimate contact with the workers of the various agencies and with the special 
needs of the various agencies. 

In the work of child guidance and of parent guidance the social worker takes an 
increasingly important place, and the work involved in the discussion of parental 
and of marital problems steadily increases. 

In regard to the court cases which have always required a great deal of time for 
the gathering of important data the psychiatric social worker during the past year 
has, in addition, followed up many of the individual cases until they have been 
placed under the care of some other agency. The psychiatric social worker often 
has appeared in court in order to explain, if necessary, the formal psychiatric con- 
clusions and to discuss matters with judge or probation officer, and sometimes has 
undertaken on request the supervision of the case. An example of this type of 
activity is given in the report of the chief social worker. In this way the work with 
cases referred by the courts has been less of a routine nature; there has been in- 
creasing emphasis on going beyond the stage of a mere formal diagnosis and report 
and on emphasizing the problem of constructive work with the individual case. 

One of the important services of the social service department is to keep in 
contact with discharged patients who may still be somewhat vulnerable and re- 
quire a little supervision or assistance. It is creditable to the social service depart- 
ment that patients who have not been at the hospital for over ten years sometimes 
call up the department when they are in some personal trouble. Sometimes the 
patient may not wish to consult the physician in case a return to hospital care 
might be insisted on, and may hesitate to call up a social welfare agency for some 
other reason. The social service department seems to be looked upon as repre- 
senting a source of help to which they can appeal with the greatest freedom. 

On Research 

One of the functions of the hospital is to promote research into the causes and 
cure of mental disorders; during the past year as in previous years a series of 
investigations have been carried on in the effort to penetrate further into the inti- 
mate mechanisms of mental disorders, with prevention or cure as the ultimate 
goal of such research. Research does not necessarily have an immediately practical 
goal and should not be expected at every stage to show the cash value of every small 
acquisition of knowledge. Important practical benefits are frequently derived from 
research, which is not directed at immediate gains but which is the expression of a 
restless intellectual curiosity working in the special field of the worker's own choice. 
This intellectual curiosity may be as active in the wards as in the laboratories. It 
may play as constantly upon the complexities of human relations as upon the 
nature of chemical processes. 

In the Boston Psychopathic Hospital there is a wide choice of topics available 
for research. There are problems of the personality and of the adaptation of 
individuals of different types to various social factors. There are problems of the 
influence of the school and of the home, problems dealing with industry and the 



P.D. 137 



11 



choice of vocation, problems dealing with the varied creeds of man and the part 
they play in his adaptation to the stress of life. There are problems connected with 
the symptoms of various types of illness, with infectious and defensive processes, 
with the effect of different therapeutic procedures, with the internal chemical 
regulation of the body. The diversity of interests can be seen by anyone who 
glances through this report. He will see in the extremely concise report from the 
psychological laboratory how Dr. Wells and his co-workers have been consistently 
studying the improvement of psychometric technique, the application of such a 
special test as the Rorschach Test to the analysis of personality, the detailed steps 
in the mental evolution of the infant and the pre-school child. 

In the report from Dr. Solomon's department one gets a condensed reference 
to technical methods of studying the processes at the basis of certain clinical con- 
ditions, and to various methods of therapeutic attack. He also discusses some of 
the general administrative problems of a special clinic and the varied human factors 
that enter into the work of such a clinic. 

Dr. Grabfield, while supervising the general procedures for the routine laboratory 
studies that are made of blood, cerebro-spinal fluid and urine etc., carries on with 
the somewhat limited facilities at his disposal a continued series of researches on 
the intimate chemical changes which are at the basis of the vital functions. 

The type of result reached by the various investigative activities is seen at a 
glance in the list of publications from the hospital, among which one may call 
attention to two studies of Dr. Agnes Goldman Sanborn on the bacteriology of the 
gastro-intestinal tract which have been published in the Journal of Infectious 
Diseases. 

Of more obvious human interest is the continued research on the schizophrenic 
disorders, that is, on those serious disorders which alienate the patients seriously 
from their fellows; the patients wrapped up in their preoccupations and delusions 
may have to lead long periods of their lives away from the rather exigent normal 
cultural environment in the tolerant and considerate environment of the state 
hospital. This investigation has involved the careful review and analysis of large 
series of case histories, with special attention paid to the varied needs and weak- 
nesses of the patients, the special stresses and strains to which they have been sub- 
jected during their lives, the presence or absence of helpful cultural resources, the 
role of special factors in family life, sex adaptation, religious beliefs. It is hoped 
that this matieral will not only throw some light on the problems of mental dis- 
orders, but will be of some value to those working in the general field of sociology. 

It is to be regretted that investigation into the neuropathological basis of mental 
disorders at the hospital still remains neglected as the hospital is without its own 
pathologist. Dr. Fulstow, the state pathologist who had been acting as chief of 
the neuropathological laboratory, resigned from her position September 1, 1931. 
Since her resignation Dr. M. M. Canavan has been acting as state pathologist and 
taking charge of the routine pathological work of the hospital. 

Ox THE Work of the Out-Patient Department 
There are many patients who are still able to carry on their work at home or at 
their daily vocation who require psychiatric treatment but who do not require 
to interrupt their outside program and come into the hospital. The out-patient 
department offers such patients the special help which they need and enables many 
individuals to carry on in a productive way with life made much more tolerable. 

Old traditions are modified slowly, names and associations continue to exert 
much influence on human behaviour. Many patients would take advantage of 
the facilities available at the hospital were it not for the fact that the term" psycho- 
pathic" still has a dread significance for them. It is probably better, however, 
that people should slowly learn to deal honestly with real factors than that one 
should try by fine names to evade serious issues. As a matter of fact, the out- 
patient department with its present limited personnel has as many patients as it 
can efficiently handle, so long as it gives adequate attention to the problems of 
the individual case. 

It is gratifying to observe the general development of mental hygiene facilities 
in Boston, a development which is reflected in the somewhat changing demands 



12 



P.D. 137 



made upon the out-patient department. The minor disorders of childhood such 
as tantrums, enuresis, night terrors, capriciousness with regard to food, etc., are 
evidently being dealt with now by the many clinics which have sprung up in the 
last few years in order to direct parents in the formation of the habits of their 
children. The more complex nervous disorders of childhood are now more promi- 
nent in the children who are brought to the out-patient department for advice. 

The consultation basis, upon which the out-patient department is run, functions 
very satisfactorily and appears to be appreciated by the agencies which utilize 
the clinic. 

Special attention has been given to developing cooperation with the workers in 
agencies, which make use of the clinic, and this cooperation has been specially 
encouraged by means of the Friday morning conferences in the Out-Patient de- 
partment which have been organized with the general welfare agencies. In these 
conferences workers from outside agencies are encouraged to bring up their problems, 
outline the type of help which they desire from the hospital and the resources which 
they have for helping the hospital to carry out its special task. In the past there 
has been a tendency for contact with the agencies to be of a rather formal nature; 
cases have been referred with insufficient data and for ill-defined reasons and re- 
ports from the hospital, couched in somewhat technical terms, have been read with 
little gain and with no further inquiry as to the substance of the report. The 
personal presence of the workers at the Friday morning conferences has made a 
material difference in this situation, and it is felt that now the individual agencies 
realize more clearly what the hospital has to oflfer in the way of diagnosis and recom- 
mendations for treatment, while the hospital is better aware of certain special 
facilities which are available through the agencies in the way of better living 
opportunities for the children examined and of special training for those with 
special abilities and disabilities. In this way the work of the physician is made 
much more readily available to such important community organizations as the 
Community Health Association, the Family Welfare Society, the Federated Jewish 
Charities, various child-placing agencies, agencies dealing with unmarried mothers, 
special agencies for vocational placement. 

Special forms have been drawn up so that in the individual case the agency can 
outline clearly the nature of the service desired from the hospital and can supply 
the type of data which are required for an intelligent study of the case. 

On the General Administration of the Hospital 
The annual report indicates the variety of functions and the number of depart- 
ments which are involved in the work of the hospital and some reference has been 
made to each of these activities in detail. The coordination of these activities is 
an important problem, and for the efficient work of the hospital there must be not 
only efficient clinical and investigative personnel but there must be the efficient 
organization of the general service personnel, with attention to supplies, upkeep of 
plant and careful supervision of many formal and administrative details connected 
with the admission and discharge of patients and with contact with relatives. The 
smooth running of the hospital is very largely due to the personality of Dr. Arthur 
N. Ball who has been its Chief Executive Officer for 3 years and whom the staff 
sees with regret transferred to another sphere of activity. 

I take this opportunity to express my appreciation of the spirit of good will, 
industry and devotion which characterizes the medical staff and the general per- 
sonnel of the hospital. It is also a pleasure to thank the Board of Trustees for 
their cordial cooperation and to express admiration for the continued interest 
which they take in all problems of the hospital and for their willingness, whenever 
called upon, to give generously of their time and advice; in equal measure one 
appreciates the support consistently received from Dr. Kline, Commissioner of 
Mental Diseases, who has always dealt in a receptive and constructive way with 
the problems which are brought to him for his consideration. 

Respectfully submitted, 

C. MACFIE CAMPBELL, 

Medical Director. 



:D. 137 



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P.D 137 



15 



REPORT OF THE OUT-PATIENT DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith submit the report of the work of the Out-Patient Department for 
the year ending November 30^ 1931. 

The staff of the clinic during the past year was as follows: 

Dr. C. Macfie Campbell, Director of the Hospital. 

Dr. Oscar J. Raeder, Chief of Out-Patient Department. 

Dr. Mary Palmer, Assistant Physician. 

Dr. Charles B. Sullivan, Assistant Physician, part time. 

Miss Annie C. Porter, Clinic Manager. 

Special ivorkers: Dr. Marianna Taylor, Dr. Henry Norman, Dr. Dorothy Green 
Dr. Ella Prescott Cahill, Dr. Henry B. Elkind. 

Students: Albert Hirsheimer, November 15 to December 18, 1930; George L. 
Young, December 19, 1930, to January 29, 1931; Edward K. Stimpson, January 
30, to February 27, 1931; Milton H. ClifiFord, May 4 to May 16, 1931; Jacques S. 
Gottlieb September 29 to October 24, 1931. 

During the year 1930-1931 the Out-Patient Department has continued to 
function as the medium between the hospital and the community, the medium 
through which 1,100 new patients have received advice and treatment that has 
helped them in making mental, social, and economic adjustments in their homes 
and in their communities. 195 of these cases were treated in the Division for 
Syphilis. Of the 905 remaining, 397 or 45<^c were adults, 188 or 20 were 
adolescents, and 320 or 35% were children. Their problems have been diverse: — 
personal, educational, vocational, and domestic, — involving a detailed study 
of the personality of the individual patient and of his environment. Many patients 
have received a routine examination in relation to adoption, court disposition, etc. 
Over one-third of the patients have been referred by social agencies. Many of 
these cases are taken over directly for treatment and follow-up by the Social 
Service Department. 

Among the adults the diagnosis* of psychoneurosis was most frequently made, 
87 cases. This group forms a large part of the daily work of the clinic, since these 
cases are in great majority treated and followed up by the clinic. The psychoses 
were next in order of frequency, 77 cases. Almost all of these were referred to 
state hospitals, a large number being admitted to the Boston Psychopathic Hospital. 
The most common psychoses were the manic-depressive, 28 cases, and the schizo- 
phrenic, 20 cases. Among those of uncertain or tentative diagnosis there were 16 
cases considered psychotic. Among the other psychoses there were 4 cases of 
general paresis, 6 paranoid conditions and 2 cases developing post-partum. There 
were 7 patients who were addicted to alcohol, one of whom was psychotic. 

Among the adolescents and children, feeblemindedness was again the most fre- 
quent cause for consultation. In many children brought in for conduct disorders 
the basis of the trouble was found to be defective intelligence. There were 78 
cases found to be feebleminded, of which 69 were children and adolescents. Be- 
sides this there were 116 cases of so-called retarded and borderline intelligence, 
i.e. bordering on feeblemindedness, of which 100 were children and adolescents. 

One hundred twenty-two cases tested psychometrically were rated as of average 
intelligence and 16 as of superior or better than average intelligence. Of these 
122 cases of average intelligence 102 were children, and among the 16 superior 
11 were children. Feeblemindedness, therefore, is essentially a children's problem 
in the work of the clinic. Among the children examined there were 26 neurotic, 
17 with reading disabilities, and 23 normal, the last mostly cases examined for 
adoption. A special reading disability was often found to be responsible for the 
child being one or more grades behind or in a special class, whereas the intelligence, 
rated by non-reading tests, might be normal or better. Special tutoring in reading, 
often very difficult to arrange in practice, is recommended for these children. 

Endocrine signs and symptoms were not infrequently found, occurring especially 
among children, and wherever it was thought that these might indicate an active 
disorder, the patients have been referred to clinics at general hospitals for more 
detailed study, especially where such study entailed short periods of hospitalization. 
Ten cases have been so studied. 



*See statistical tables following. 



16 



P.D. 137 



The new law requiring mental examination of delinquent children before their 
commitment to reform schools became effective on April 16, 1931 (Chapter 215, 
Acts of 1931). Under the provisions of this chapter we have examined in the Out- 
Patient Department (statistical year ending September 30, 1931) 11 children, 9 
of whom were girls, and 2 boys. Of this number 2, 1 boy and 1 girl, had been pre- 
visouly seen in the Out-Patient Department. Of these cases only 3, 2 boys and 
1 girl, came directly from the courts. The remainder, 8 girls, came through social 
agencies, 7 from the S.P.C.C., and the other from the Division of Child Guardian- 
ship of the State Department of Public Welfare. Institutional care was advised 
for 5 children, 1 boy and 4 girls. Placement in foster homes was advised for 6 
children, 1 boy and 5 girls. 

An extra-mural function of the clinic is the survey of the Brookline schools, 
conducted again this year by Dr. Mary Palmer with the aid of a psychologist, a 
social worker, and the school nurse. 

School Survey of Brookline Schools, 1930-1931 
School Clinic Staff: Dr. Mary Palmer, Psychiatrist, Mrs. Gertrude Pierce, 
Teacher; Miss Viola Jones, Psychologist; Mrs. Rena Dewey, Social Worker; 
Mrs. Ada Joyce, Visiting Teacher. 



Names of Schools and Number of Pupils Referred 



Baldwin 
Cabot . 
Driscoll 
Devotion 
Total 



2 Heath . 

1 Lawrence 

4 Parsons 

8 Lincoln 



9 Pierce . 

Runkle 

5 Sewall 

28 Winthrop 



14 

8 
2 

81 



Pupils in Survey first time: Boys, 38; girls, 21. 
Pupils in previous Survey: Boys, 19; girls, 3. 

Classification of Pupils examined for the first time on basis of Intelligence Quotient 



I.Q. 69 or less 


I.Q. 70-79 


I.Q. 80-89 


I.Q. 90-109 


I.Q. 110 and 
above 


M. F. T. 

2 2 


M. F. T. 

15 5 20 


M. F. T. 

8 9 17 


M. F. T. 

13 5 18 


M. F. T. 

2 2 


Classification of Pupils re-examined in 1930-1931 


I. Q. 69 or less 


I. Q. 70-79 


I.Q. 80-89 


I. Q. 90-109 


I.Q. llOorabove 


M. F. T. 

3 1 4 


M. F. T. 

6 2 8 


M. F. T. 

5 5 


M. F. T. 

5 5 


M. F. T. 





Of the cases studied, it was recommended that 14, of whom 12 were boys and 2 
girls should be placed in a special class. 

On the basis of chtonological age, using age of pupil in first grade as a standard, 
either 514 years or 6H years, as the case may be: 
45 pupils were approximately 2 years retarded. 
12 pupils were approximately 3 years retarded. 
Group showing retardation of approximately 2 years: 
3 pupils had an I. Q. of 69 or less. 
14 pupils had an I. Q. or 70-79. 
12 pupils had an I. Q. of 80-89. 
16 pupils had an I. Q. of 90-109. 
19 pupils of this group showed reading disability. 



P.D. 137 



1,7 



Group showing retardation of 3 years: 
8 pupils had an I. Q. of 70-79. 
2 pupils had an I. Q. of 80-89. 
2 pupils had an I. Q. of 90 -109. 
!. 6 pupils of this group showed a special reading disability. 

The following statistical tables are self-explanatory and deal further with the 
work of the clinic. 



Statistics of the Out-Patiext Department 
October 1, 1930 to September 30, 1931 









1 1 on 






906 








195 




New Patients: 










Male 


Female 


Total 




174 


223 


397 


Adolescents 


71 


117 


188 




202 


118 


320 




447 


458 


905 


Plus: 










86 


109 


195 




533 


567 


1,100 


Referred By 










Male 


Female 


Total 


Relatives, friends, and own initiative . 


. 75 


62 


137 


D. M. D., State House 


2 





2 


Boston Psychopathic Hospital .... 


16 


18 


34 


Other Hospitals 


75 


60 


135 


Private Physicians 


70 


48 


118 


Social agencies 


. 123 


239 


362 


Court 


27 


9 


36 


School 


57 


22 


79 


Church 


2 





2 




447 


458 


905 



Problems 

a. Behavior: Larceny, misconduct, sex delinquency, temper tantrums, seclus- 
iveness, masturbation, lying, litigiousness, running away, cruelty to animals and 
children. 

b. School: Truancy, retardation, speech defect, intelligence rating, reading 
difficulty. 

c. Personality: Deterioration, maladjustment in employment, irresponsibility, 
distractibility, lack of interest, lack of self-confidence, personality change, lack of 
social adjustment. 

d. Domestic: Marital difficulty, question of re-establishing home, home situation. 

e. Vocational: Inability to work, maladjustment. 

/. Neuropathic: Restlessness, tic and twitching, fears, shock, hallucinations, 
epileptic spells, compulsions, itching, anger, somnambulism, fainting spells, exhi- 
bitionism, failing memory, drugs, depression, somatic complaints, tremors, paranoid 
ideas, nervousness, stuttering, feeding problem, suicidal tendencies, alcoholism, 
night terrors, confusion, feeling of apprehension, hysteria, enuresis, worry, in- 
feriority complex, emotional instability, irritability, crying spells, sleepiness, finger- 
sucking, numbness, insomnia, screaming spells, dizziness, blank spells, nightmares. 

g. Need of routine examination for adoption, for court disposition, etc. 



18 



Diagnosies 

Psychoses: 

Senile 

With cerebral arteriosclerosis .... 

General paresis 

With other brain or nervous diseases: 

Paralysis agitans 

Tabes 

Alcoholic 

With other somatic conditions — puerperal 

Manic-depressive 

Involutional melancholia 

Dementia praecox 

Paranoia and paranoid conditions 

Psychoneuroses and neuroses .... 

With mental deficiency 

Undiagnosed 

Without Psychoses: 

Epilepsy 

Alcoholism 

Psychopathic personality 

Other conditions (not specified) 
Psychopathic personality with feeblemindedness 
Constitutional psychopathic inferiority . 

Neurotic child 

Parkinson's disease 

Encephalitis lethargica 

Pituitary gonad syndrome 

Organic brain disease 

Multiple sclerosis 

Abnormal environment 

Normal child 

Conduct disorder 

Defective delinquent 

Reading disability 

Facial tic 

Narcolepsy 

No nervous or mental disease .... 

Multiple neuritis 

Spoiled child 

Diagnosis deferred 

Uncertain diagnosis 

Without psychosis (referred for intelligence rating) : 

Superior intelligence 

Average intelligence 

Retarded intelligence 

Mental deficiency 

Imbecile 

Mongolian Idiot 

Total 

Disposition 

Treatment in Out-Patient Department 
Admitted to Boston Psychopathic Hospital . 
Institution for F. M. advised ... 

State hospital advised 

Referred to general hospital 

Report to court 



P.D. 137 19 
Report to social agency 206 253 459 



Total 447 458 905 

Visits 

Total Visits 2617 

Visits of New Patients 2005 

Out-Patient Department 1810 

Syphilis Clinic 195 

Visits of Old Patients 612 

Clinic Days 299 

Average attendance per day 8 



Number of Patients and Number of Visits per Year 



Patients 


Visits 


Total Visits New Patients 


Visits 


Total Visits 


105 


1 


iOD 


oy4 


1 


594 


64 


o 


128 


153 




OUO 


20 


3 


60 


56 


3 


168 


12 


4 


48 


34 


4 


136 


7 


5 


35 


20 


5 


100 


6 


6 


35 


8 


6 


48 


3 


7 


21 


8 


7 


56 


3 


8 


24 


8 


8 


64 


1 


9 


9 


4 


9 


36 


1 


10 


10 


4 


10 


40 


3 


11 


33 


7 


11 


77 


1 


13 


13 


1 


12 


12 


1 


14 


14 


1 


13 


13 


1 


16 


16 


1 


14 


14 


1 


27 


27 


2 


19 


38 


1 


34 


34 


1 


23 


23 








2 


26 


52 








1 


33 


33 


230 




612 


905 




1810 



Clinical staff meetings presided over by the director have been held bi-weekly 
as before and played an important part in the study of patients, the teaching of 
students in medicine, psychology, social work, and nursing. 

During the past year executive meetings have been held on Fridays for the dis- 
cussion of cases with special reference to disposition and relationship between the 
clinic and referring agencies. The innovation of opening these meetings to workers 
in these agencies has been of great help mutually in promoting a better under- 
standing and easier cooperation. Workers from almost all of these agencies and 
from special institutions and schools have been present at various times during 
the year 

I take this opportunity to express appreciation to Dr. A. W. Rowe of the Evans 
Memorial Hospital for his valuable reports of studies on endocrine cases referred 
by this clinic, and to call attention to the whole-hearted cooperation of the various 
members of the staff — physicians, psychologists, social workers, and others in the 
work of the clinic. 

Respectfully submitted, 

OSCAR J. RAEDER, 

Chief of Out- Patient Department. 

REPORT OF THE CHIEF MEDICAL OFFICER 
To the Medical Director of the Boaton Psychopathic Hospital: 
I hereby submit the report of the Medical Service. 

As this is my tenth annual report as Chief Medical Officer, it seems worthwhile 
to summarize some of the points that seem of interest, to point out certain changes 
which have occurred, and to suggest changes for the future which would be con- 
sidered desirable. 



20 



P.D. 137 



The general admission rate to the hospital has changed but little during the past 
ten years. The last year has, however, had a larger admission rate than the 
average. It is of considerable interest that the number of voluntary admissions 
has dropped from 14.8 per cent, in 1921 to .07 per cent, in 1930. This has been 
due largely to the legal aspects since the Massachusetts courts have made a ruling 
which increased the limitations upon the ability of a person mentally sick to sign 
a voluntary commitment paper. It should be noted, however, that the figures 
just quoted apply to first admissions only. The present tendency is to accept 
patients under the ten-day commitment paper under Section 79 of the statutes, 
and later to allow the patient to go onto a voluntary status if that seems proper 
and desirable. The result of these two conditions, however, has been to produce 
a marked lowering of the number of voluntary first admissions. 

The past ten years have showed a marked increase of cases referred to this 
hospital by the courts under Section 100 of the statutes. In 1921, 3.7 per cent, 
of all first admissions were sent by the courts under this provision, whereas in 
1930, 10.3 per cent, were so received. These figures are gratifying in that they 
show an increased use of this hospital by the courts, and indicate that the judges 
are regarding psychiatric examinations as of greater importance. 

It has been noted that certain courts refer many cases who show little evidence 
of mental disorder and are not found to be committable, whereas other courts send 
in a much higher percentage of cases who are found to be commitable. In checking 
this matter up it is found that where the services of a psychiatrist are available to 
the court, the selection of cases referred to this hospital shows a much higher per- 
centage of commitable cases. 

Although the general activities of this hospital have increased greatly during the 
past ten years, the building and general equipment are unchanged. This has 
resulted in a great deal of crowding, has definitely limited the work of many 
departments and has prevented the expansion and growth of the work of this 
hospital in the manner which would be desired. The X-ray department represents 
one of the few departments which has been able to grow and expand in the manner 
desired. We now have a very satisfactory x-ray equipment, a full-time technician, 
and are able to do excellent diagnostic work. Lack of funds has hampered some- 
what the use of this department. There has been expansion in the way of additional 
room and equipment for electrotherapy. We have installed equipment for, and 
are giving treatments with diathermy, ultra-violet rays and infra-red rays. 

There is, unfortunately, no suitable provision for isolation of patients with in- 
fectious or contagious diseases, and without further building there seems to be no 
way of making such provision in a really satisfactory manner. This means that 
whenever infectious cases are admitted to the hospital entire wards or services or 
even the whole hospital must be quarantined. This prevents the transfer of patients 
to other hospitals and the admission of new patients, and interferes with the general 
routine of the hospital. There is no way of caring for sick employees except to 
place them on the wards with patients who are mentally sick. As there are few 
single rooms where such employees m.ay be isolated, this has at times presented 
quite a problem. 

With an admission rate of nearly 2,000 patients a year and only 100 beds avail- 
able, it has been impossible to keep for further study and treatment many cases 
which otherwise would have been suitable to keep. When some of the 100 beds 
available have to be utilized for sick employees, it cuts down still further the 
number of beds available for mentally sick patients. With the amount of research 
work going on at this hospital at the present time, it is sometimes difficult to allot 
the beds required by the individual projects. If more beds were available much 
more elaborate studies could be carried out with very little increase of personnel. 

During the past year Wards A and B have been open continuously and have 
been filled by cases of general paresis, epilepsy and stupor, as these disorders were 
the subject of special investigation. 

Although laboratory facilities have increased, and more equipment has been 
added during the past year, there is still need of further equipment. The limita- 
tion of laboratory space, however, makes it diflficult to find place for such new 
equipment, if it were obtained. At the present time the hospital needs a string 



P.D. 137 



21 



galvanometer not only for the study of heart conditions, but also for the more 
delicate analysis of many motor reactions. An audiometer is likewise needed. 

Due to lack of space it has not been possible to offer opportunities to work at 
the hospital to all the doctors who have applied. The desire of the physicians to 
receive training at this hospital has resulted in actual saving in dollars and cents to 
the state, since the regular clinical staff is paid a much lower salary rate than is 
paid throughout the rest of the state hospital system. Many physicians have come 
to work on an unsalaried basis. Such an arrangement is of advantage both to the 
hospital and to the physicians, and it is regretted that it has been impossible to 
accomodate all of the physicians who have applied. 

The number of social workers at the hospital is so limited that the obligatory 
time taken up by investigation of cases sent in by the courts leaves a quite inade- 
quate time for the follow-up treatment and after-care of patients leaving the 
hospital. An increase in the number of social workers would improve the treatment 
and after-care of our patients. 

The report of Dr. Dalton, the resident dentist, follows: 

Patients examined 1,744 

Patients receiving treatment 925 

Extractions 1,023 

Fillings 436 

Prophylaxis 235 

Other treatments 189 

Dental x-rays of 50 cases: Infection found in, 22; doubtful infection, 13; neg- 
ative, 15; impactions, 5; cyst, 1; rudimentary tooth, 1. 

It will be seen that practically all patients admitted to this hospital receive a 
dental examination, and approximately half of them receive dental treatment of 
some sort. 

The table of X-ray examinations for the year: 
Month Male Female Total 



December, 1930 


34 


19 


53 


January, 1931 


28 


25 


53 


February 


39 


28 


67 


March 


22 


40 


62 


April 


37 


27 


64 


May 


26 


25 


51 


June 


13 


7 


20 


July 


25 


26 


51 


August 


28 


27 


55 


September 


25 


9 


33 


October 


29 


25 


54 


November 


24 


14 


38 




329 


272 


601 





Dec. 


Jan. 


Feb. 


Mar 


Apr. 


May 


June 


July 


Aug. 


Sept 


Oct. 


Nov. 


Total 


Skull 


24 


19 


27 


22 


26 


20 


9 


22 


20 


8 


18 


12 


227 


Gastro-intestinal series 


2 


S 


5 


3 


3 








2 


3 


6 


3 


1 


33 


Spine 


3 


2 


3 


5 


2 


3 







4 


3 


2 


1 


29 


Hands and Fet- 1 


4 


6 


2 


9 


7 


8 


4 


5 


3 





3 


7 


58 


Sinuses 


3 


2 


1 


5 


1 


2 





3 


1 





2 


1 


21 


Pneumograph 


1 


2 




2 


3 


3 





4 


3 


1 


1 





21 


Chest 


10 


12 


20 


22 


15 


13 


7 


14 


17 


9 


16 


12 


167 



Respectfully submitted, 

KARL M. BOWMAN, 

Chief Medical Officer. 



22 



P.D. 137 



REPORT OF THE BIOCHEMICAL LABORATORY 
To the Director of the Boston Psychopathic Hospital: 

In the past year, there have been no essential changes in the work of the Bio- 
chemical Laboratory and the personnel has remained unchanged until this fall, 
when our junior chemist, Miss A, G. Campbell, left us to get married, She was 
been replaced by Mrs. Madeleine Bishop. The entire student-interne force has 
been changed this fall, and we have been fortunate to secure, as the senior interne, 
Dr. J. R. Frazee, who has completed his interneship at the Children's Hospital 
and is now working in the Pathological Department of the Eye and Ear Infirmary; 
the other three men are medical students of the second and third year classes. 

This year we have completed the study of the relationship of blood cholesterol 
and the low basal metabolic rates, so frequently seen in our patients. We were 
able to show a complete absence of correlation between these two vital figures. 
This work is of some slight importance as a further indiciaton that the low^ basal 
metabolic rates in mental disease are not always dependent upon deficient thyroid 
function. The work on the ejects of gelatine diets on the nitrogenous constituents 
of the blood is being slowly carried forward as time permits. This is related more 
closely to certain general problems of Internal Medicine than to the special problems 
of psychiatry. Our patients make particularly good subjects for this study and 
it can be organized to fill the empty time of the laboratory caused by the variation 
in amount of routine hospital work. 

The co-operation between the clinical staff and the laboratory has been unusually 
satisfactory and close in the past year, and leads to the hope that in the near future 
we shall be able to devise some method whereby the increasing number of fellows 
and other graduate workers may use the laboratory in the solution of the problems 
on which they are engaged. It is not clear, in my mind, whether these students of 
psychiatry should be attached to the iaboratoi*y in every case during a certain 
period of their training, or whether the best method would be to require a laboratory 
approach to some problem as a portion of their training. This could be done in two 
ways, either by insisting that they do the laboratory work themselves, or by th% 
utilization of the present laboratory personnel in acquiring such data as they need. 

It seems fairly obvious that psychiatry has outgrown the purely observational 
and classificatory stage and is now entering the group of experimental sciences. 
Many leads have been secured as to the connection between the various physio- 
logical mechanisms and the psyche. It seems to us that our graduate students in 
psychiatry should be more than encouraged to get at least a glimpse of the exper- 
mental field. As it is now organized, the laboratory is more than ever capable of 
providing the necessary facilities, with certain definite restrictions of space. If 
such a plan were to be decided on, adjoining space originally intended for laboratory 
purposes might be made available. 

Staff for the past year has been: 

Junior Chemist — A. G. Campbell, 

Student Internes — George Salter, Ernest Joy, George Krinsky and Jacques 
Rosemann. 

Respectfully submitted, 

G. PHILIP GRABFIELD, M.D., 

Chief of Biochemical Laboratory. 

REPORT OF THE PSYCHOLOGICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

From the standpoint of psychometric techniques the chief accomplishment during 
the year has been the completion of the previously mentioned revision of the Army 
Alpha test. With the continued cooperation of the laboratory personnel and of 
the printing department at Gardner the five forms are now available in the revised 
status. The Psychological Corporation is undertaking arrangements for their 
publication. 

Among non-language pencil and paper tests the Army Beta shares with Army 
Alpha peculiar advantages in respect to standardization. Its original layout made 
administration, except on a large scale, extremely difficult. A means was devised 
in the laboratory which renders it easily applicable to individuals and small groups. 



P.D. 137 



23 



It is a very satisfactory, not to say economical, substitute for the ordinary ' per- 
formance" techniques in cases of language difficulty; it is also most probable that 
it reaches oth^r intellectual qualities than does Army Alpha, though its interpre- 
tation at this level is still quite unclear. 

In respect to research, Mr. Beck continues his work with the Rorschach test, 
and Miss Viola Jones develops her interest in the problems of the pre-school child, 
and of reading difficulties. Mr. Atwell is investigating a possibility of shortening 
the Alpha examinations without sacrifice of validity. It has seemed unwise for 
the writer to undertake new projects in research until conditions should permit 
fairly complete digestion of the considerable research material already gathered. 
This has been described in previous reports, it is concerned mainly with learning 
functions, and has educational and re-educational bearings. Little progress in 
this direction has been made during the past year, or is in immediate prospect, 
with the present limitations of space and personnel. Energies have been turned 
rather towards development of teaching functions in the laboratory. A number 
of sessions on psychological topics relevant to their interests have been held with 
the medical staff and with members of the psychological and social service staffs, 
which it is planned to continue. Certain special teaching devices are being 
developed. There is little doubt that in the existing circumstances this is the better 
utilization of the laboratory's resources. 

The lack of quarters adjusted to the growing functions of the department as 
hampering not only its immediate and special activities, but also its proper co- 
operation with other research prosecuted in the institution in which the factor of 
experimental psychology is important, was made the subject of a special memoran- 
dum submitted to the Medical Director on June 22, 1931. An increasing tendency 
is also apparent, for outside agencies to call on the institution for its psychometric 
resources in and for themselves. As this intereferes with the regular service of the 
laboratory to the hospital it has been possible to meet this demand only in a very 
limited way. It is, nevertheless, a reasonable demand, as there is genuine need 
for such service among social agencies whose resources do not permit the employ- 
ment of a competent examiner in their own organization. The demands of the 
school survey also constitute a serious drain on the intramural service which the 
laboratory can render. The satisfactory meeting of these conditions requires the 
addition to the laboratory staff of a psychologist (not psychometrist ) of some 
experience in child psychology whose primary responsibility would be to care for 
the various extramural demands on the institution, of a psychological nature. 

There has been the usual participation in conferences of national scope concerned 
with psychological or mental hygiene matters. Mr. Beck has considerable editorial 
responsibility for the American Journal of Orthopsychiatry. The laboratory con- 
tinues its cooperation in Psychological Abstracts, the Psychological Index, and 
the Child Development Abstracts. Official relations to the Division of Psychology 
and Anthropology of the National Research Council, the Psychological Corporation, 
and the National Institute of Psychology, continue substantially as heretofore. 
Some committee work is being carried on for the Social Science Research Council. 

As to changes in the laboratory staff, Mr. S. J. Beck continues as psychologist 
and Miss V. M. Jones as psychometrist. Miss Albertine Ragsdale resigned as 
psychometrist on September 19, 1931, and Mr. C. R. Atwell was appointed in 
her place. 

Publications have been as follows: 
Beck, S. J. "Personality Diagnosis by Means of the Rorschach Test." Ameri- 
can Journal of Orthopsychiatry, 1930, Vol. 1, No. 1, 81-88. 
Beck, S. J. "The Rorschach Test in Problem Children." American Journal of 

Orthopsychiatry, 1931, Vol. 1, No. 5, 501-511. 
Beck, S. J. and Levy, D. M. "The Rorschach Test in Manic- Depressive 
Psychosis." Manic-depressive Psychosis. Volume XI, Pp. 167-181, Re- 
search Publications, Association for Research in Nervous and Mental Disease. 
Baltimore: Williams & Wilkins Company, 1931. 



24 



P.D. 137 



Wells, F. L. ' Comparative Psychology and Mental Hygiene." American 

Journal of Orthopsychiatry, 1931, Vol. 1, Xo. 4, 400-405. 
Wells, F. L. Re\iew of ' Culture and Progress" by W. D. Wallis. Journal of 
Philosophy, 1931, Vol. 28, No. 20, 550-567. 

Respectfully submitted, 

F. L. WELLS, 

Head Psychologist. 

REPORT OF THE NEUROPATHOLOGICAL LABORATORY 

To the Director of the Boston Psychopathic Hospital: 

As has been the custom since 1914, the autopsies and bacteriological work for 
the hospital have been done by the Pathologist and Student Interne for the De- 
partment of Mental Diseases who are quartered here. The greater part of the 
autopsy work for the year has been done by Dr. Marjorie Fulstow, December 1, 
19oO-August 31, 1931, but since her resignation, by the writer. 

There have been in the period of this report, — December 1. 1930, to November 
30, 1931, 26 deaths in the hospital — a decrease from the three previous years. 
Fourteen of these have been autopsied two by the Medical Examiner ), a percentage 
of 53, the same as last year. The two done by the Medical Examiner showed 
pneumonia in one case, and the other nephritis: the first after an attempt at suicide, 
the second following some exogenous poison. Twelve other autopsies were per- 
formed by the Department's Pathologist or ones substituting therefore; infections 
of one sort or another tuberculosis in onei accounted for five; brain tumor two, 
and one each were due to hydrocephalus, general paralysis of the insane (with 
massive cerebral hemorrhage ', rupture of aorta, chronic nephritis and spontaneous 
cerebral hemorrhage. 

The specimens preserved are used in demonstrating to staff and nurses. A visit 
of the group of nurses was made to the Warren Museum where brain anatomy was 
explained. 

Mr. Aage E. Neilsen, the interne in bacteriology, reports: blood cultures, 40; 
cultures from other body fluids or exudates, 11; smears, 14; Widal tests, 2. 

Respectfully submitted, 

MYRTELLE M. CANAVAN, 
Pathologist, Department of Mental Diseases. 

REPORT OF THE DEPARTMENT OF THERAPEUTIC RESEARCH 
To the Medical Director of the Boston Psychopathic Hospital: 

This year has seen our research on stupor progress to a place where it is ready 
for publication. The work on this study is under the direct supervision of Dr. 
Frank d'Elseaux, a Commonwealth Fellow in Psychiatry, who has devoted not 
only this year, but the preceding year to this work. Associated with him is Miss 
Peterman, technician, and in addition a great deal of assistance has been rendered 
by many members of the hospital staff. 

In the limited space allowable in the annual report, only the barest outline of 
this work can be given. It has been shown that certain patients with what may be 
called stupor in the broader psychiatric use of the term, may be aroused from an 
inactive, mute state by breathing high concentrations of carbon dioxide. The first 
point to be determined was what physiological effects were produced in the patient. 
This study has given rather a complete picture of the changes in the hydrogen 
ion concentration of the blood, both arterial and venous, the carbon dioxide, 
tension, the oxygen combining power, the lactic acid formation, the effects on pulse, 
blood pressure, respiration, and temperature. The study of these factors has led 
to a number of interesting physiological observations, which will be described in 
detail in the appropriate place. It may be stated here, that none of the factors 
studied are in themselves a sufficient explanation of the psychological phenomenon 
that follows the treatment. As a brief example, the following may be noted. 

With a high concentration of carbon dioxide, the patient is thrown into 
and acidotic state with the Ph of the blood dropping as low as 6.89. Nevertheless, 
is has been shown that with similarly low Ph, the effect on the mental status of the 
patient may be relatively unimportant, while with a Ph that is higher, the effect 



P.D. 137 



25 



may be much greater. In the further course of the study, it was shown that when 
the patient was made relatively alkalotic by ingestion of sodium bicarbonate, an 
even more striking improvement in the mental symptoms over a longer period 
could be obtained. In summary, it may be stated that the results of our studies, 
as far as getting a knowledge of the factors producing the change in mental status 
of the patient, may be said to be completely negative. However, this work has, in 
our opinion, entirely disproved a number of hypotheses that have been advanced, 
and in this way has reduced the confusion and clarified the issue, A considerable 
amont of work on the lines already undertaken remains to be finished. 

Not the least important result of this study has been the development of a well- 
equipped and well-functioning biochemical laboratory prepared to handle the 
various researches of the hospital staflF. 

The studies in the treatment of epilepsy have met with the usual difficulties 
incident to this problem. We are not able to report any great therapeutic achieve- 
ment, nor any fundamental discoveries. Nevertheless, a number of important 
and interesting observations have been accumulated which will form a basis of 
therapeutic procedures that can be carried on in patients not kept in a hospital. 
The work has been done almost exclusively on a very few patients kept for many 
months under careful control, and studied as to the effect of dehydration, acidosis, 
produced by chemicals and diet, alkalosis, and to a limited degree, starvation. 
Studies of this sort require a great deal of time, and as yet we are hardly more than 
well started. We expect to continue this work over an indefinite period. 

In the treatment of neurosyphilis, a new procedure introduced this year is the 
use of diathermy to produce fever. We have been fortunate enough to acquire a 
recent model of a diathermy apparatus more efficient than any heretofore available, 
through a grant from the DeLamar Mobile Research Fund of the Harvard Medical 
School. A diathermy machine producing a very high amperage will produce a 
fever in patients, the height of the fever being controllable within a fraction of a 
degree. A temperature of 104 to 105 degrees may be produced by this apparatus 
in the course of an hour and a quarter to an hour and a half. Fever treatment, 
which has been shown to be quite effective in the treatment of certain types of 
neurosyphilis, is thus available at all times. The first question is the relative 
efficency of fever produced in this manner and fever produced by malaria. We 
are not in a position to answer this problem as yet, but there is ample evidence 
that the diathermy method has a high therapeutic value. It would appear that 
there are advantages and disadvantages in any of the methods of fever production 
that are now available, but it is also certain that the diathermy method adds another 
very useful and effective aid in the treatment of neurosyphilis. 

Aside from the first and major problem of the therapeutic value of this procedure, 
a number of interesting associated problems are being studied, as for instance, the 
effect on the basal metabolic rate and the value of certain anti-pyretic drugs. 

At the same time that these studies are being made, the studies of the various 
other methods in the treatment of neurosyphilis continue, namely, fever produced 
by malaria and typhoid vaccine, the use of tryparsamide and the arsphenamines, 
and other anti-luetic drugs. As has been stressed in previous reports, the under- 
standing of proper treatment methods requires many years of carefully collected 
and tabulated experience. The therapeutic results now obtainable are sufficient 
justification for work of many years that has been done in this Department. For 
instance, it seems to be a reasonably conservative statement that at least one-third 
of the cases of general paresis receiving treatment at the Boston Psychopathic 
Hospital make an improvement sufficient to allow them to take up their normal 
place in the community once more. In addition to this, many other patients are 
very greatly helped. 

In the prosecution of this work, a rather large clinic has grown up, and a few 
figures may be given to indicate both the size of the clinic and its growth. During 
the statistical year of 1930, 347 individuals made 3,527 visits to the clinic. During 
the statistical year of 1931, 434 individuals made 5,106 visits to the clinic. The 
individuals referred to above fall into two groups, first, those who are under treat- 
ment; and secondly, those who came for examination, the latter group representing 
the contacts of the clinic, patients who have been in a position to have been infected 



26 



P.D. 137 



by syphilis. Of the 434 indi\iduals enumerated as having visited the clinic during 
the year, 267 fall in the group of patients receiving treatment, and these individuals 
made 4.889 \'isits, while those who came for examination number 167, and made 
217 visits. 

Increased attendance at the clinic is to be explained in slight degree by the 
economic depression, and to a ver>' much greater degree by the increase in efficiency 
of treatment methods and to no little extent by the better handling of patients. 
In dealing with a clinic of this sort, one is faced \^ith a very different situation than 
in a clinic which deals with more acute illnesses. Patients are of necessity- required 
to continue their treatment at frequent intervals over a period of years. It is 
therefore most essential, both from the standpoint of the patient treated, and value 
of records and information obtained from the study of the patients, that they be 
followed over a long period of time. This has been made possible by the excellent 
work of the Social Ser\ice Department. The social worker attached to this clinic 
manages the clinic details which include supervision of the running of the treat- 
ment clinic, the arrangement for admission of patients to the hospital for prolonged 
treatment or for temporar>' care following lumbar puncture, and it is also her 
function to obtain permits for special types of treatment, to see that the patients 
return to the clinic at the proper time, and to assist patients and their families in 
the various ways which fall under the functions of social case work. 

It is our earnest endeavor to keep in close contact with our patients and to lose 
sight of as few as possible. It is our policy to keep cases on our list for a long period, 
rather than to discontinue them on the basis that they have iasped from the clinic. 
This policy ob\iously increases the total number of cases listed as lapsed, and makes 
a poorer showing in the percentage of cases returning to the clinic. Taking the 
figures for the past year, in a total of 437 treatment cases carried, the average 
number of lapsed treatment cases per month is 175; the average number of lapsed 
cases followed monthly by the social worker is 46 or 26 ; and the average number 
returned to the clinic monthly is 18 or 39*^7 of those followed. 



The follo^^-ing shows the figures for the current year: 

Total new treatment cases 73 

Total lapses treatment 54 

Total followed by worker 54 flOO^c^ 

Total returned to clinic within two months, ... 50 ( 92%) 

Still lapsed 4 ( 8%) 



The importance of examining the families of our syphilitic patients has been stres- 
sed in previous reports. This endeavor has been continued this year, and a comparison 
of the figures of this year and the preceding year indicate with what success. In 
the year 1929-30, 197 relatives were examined, whereas in the year 1930-31, 317 
relatives were examined, showing an inr-rease of 59^7- The high degree of success 
in getting individuals in for examination is indicated by figures for the statistical 
year. There were 339 relatives of patients desired for examination, and of this 
number. 311, or 91 -c visited the clinic and were examined. 

Another aspect of the work of the social service department is the handling of 
syphilitic patients who are not to be treated in our clinic. It is our aim to see that 
these patients secure the proper treatment. It has been found that merely refer- 
ring the patient to a clinic or physician's oflfice is not sufficient, and it is therefore 
part of the service rendered to these patients to see that they actually arrive at the 
clinic or physician's office, and that information concerning them is placed at the 
disposal of those who are to care for the patient. 

The super\Tsion of this part of the hospital social service work has been under 
the charge of Mrs. Maida H. Solomon, and the work has been carried out by Miss 
Ruth Epstein. 

The following table gives a resume and picture of work done in the syphilis clinic: 

Total 

1. Total cases active on first of year 673 

Clinic register ... 364 
Syphilitic non-treatment cases 79 
Relatives for follow-up 230 



P.D. 137 



27 



0. 



New cases and readmissions 
Clinic register 

Syphilitic non-treatment cases 
Relatives for follow-up 

Total cases closed this year 
Clinic register 

Syphilitic non-treatment cases 
Relatives for follow-up 

Total cases remaining active 
Clinic register 

Syphilitic non-treatment cases 
Relatives for follow-up 



Visits made by 434 persons 

By 267 persons to clinic for treatment 
By 167 relatives for examination 



6. Total treatment given 267 cases 






• Arsphenamin 


. 596 


Mercury 


12 


Bismuth 


. 373 


Neoarsphenamin 


76 


Diathermy 


149 


Sodoku 


1 


Drainage 


2 


Tryparsamide 


2,957 


Intraspinal 


19 


Typhoid vaccine 


142 


Malaria. 


64 


Ventriculographies . 


8 



73 
138 
346 



171 
186 
365 



266 
31 
211 



4,889 
217 



557 



722 



508 



5,106 



4,399 



7. Diagnostic lumbar punctures 



1,079 



Per cent of families followed who were examined . 
Per cent of relatives followed who were examined 

Per cent of families examined showing evidence of syphilis 
Per cent of relatives examined showing evidence of syphilis 



79% 



18% 
10.9% 



The work with the epileptics and syphilitics has been carried on by Dr. S. H. 
Epstein, and during the latter part of the year he has had the assistance of Dr. 
I. Kopp. 

In all the work carried on by this Department, the greatest assistance has been 
obtained through the cooperation of almost the entire staff of the hospital, which 
is gratefully acknowledged. A large percentage of the funds required to carry 
out our investigations has been made available by the Division of Mental Hygiene 
of the Department of Mental Diseases. We have also been helped by funds secured 
from the DeLamar Mobile Research Fund of the Harvard Medical School, from 
the budget of the department of Psychiatry of the Harvard Medical School, and 
the Joseph M. Herman Research Fund. 

Respectfully submitted, 

HARRY C. SOLOMON, M.D., 

Chief of Therapeutic Research. 

REPORT OF THE CHIEF EXECUTIVE OFFICER 
To the Medical Director of the Boston Psychopathic Hospital: 

The routine executive work of the Boston Psychopathic Hospital is probably 
less stereotyped than that of any other mental hospital in the country. Almost 
daily some unprecedented problem relative to the reception, retention or dismissal 
of a patient arises. To synchronize the humanitarian, legal and sociologic aspects 
of many cases requires tact, experience and some imagination. With an annual 
turnover of around two thousand cases and a daily average population of less than 
eighty-four, there arise frequently problems to tax the facilities of the most ex- 



28 



P.D. 137 



perienced. This hospital has been very fortunate during the past year to have 
had an Assistant Executiv^e and Clinical Staff of high efficiency, so that no serious 
complications have arisen. In this connection, the ward personnel should not be 
forgotten. They have functioned with unusual faithfulness as shown by the record 
of no suicides and very few serious accidents. Not a single incident is recalled 
where relatives of patients have lodged a complaint of rough handling or other 
abuses. The employment of student nurses from general hospitals as affiliates has 
passed the experimental stage, and is now a' proven success. 

In the matter of appropriation for maintenance, the hospital has been unusually 
fortunate during the past year. The falling price of commodities has permitted a 
more liberal dietary, and there is a substantial unexpended balance under food. 
Some of this money has been transferred for the needed purchase of house furnish- 
ings. Under Personal Services, there is also a considerable balance, although the 
usual quota of employees has been maintained throughout the year. The only 
item in which the appropriation fell short of actual needs was Medical and General 
Care. Under this item, as in years past, there were not sufficient funds to purchase 
all the X-ray films and special therapeutic agents requested by the medical staff. 
This interfered in no way with routine diagnostic procedures or usual treatment, 
but did prevent the carrying out of some special research projects. 

Gradual improvement in the building has been continued. Sections unpainted 
for several years have been made much more attractive and sanitary. Over four 
hundred doors, without face casings since erection of the building, have been cased, 
doing away with much crumbling plaster. Five tons of band iron have been fitted 
about the top of flush base boards, supplying an important need overlooked by 
the builders. Several other important items under repairs and renewals have been 
completed during the year. The physical condition of the building is, however, 
far from satisfactory in many respects, and a general renovation could well be 
considered. 

As stated in previous reports, the activities of the Boston Psychopathic Hospital 
have far outgrown the physical limitations of the plant. This is especially true 
as regards the laboratory facilities, record department, and housing of employees. 
Nearly every other department has inadequate space. The building of an addition 
to the present plant, or the erection of a separate building to house employees, 
should be given immediate consideration. 

It is hoped that the foregoing will not be misconstrued as an intimation that 
the Boston Psychopathic Hospital is a battered and tottering hulk, or that it is 
not fully abreast with the times as a scientific institution. This report is intended 
principally to call attention to certain deficiencies, and not to review the excellent 
work that has made this hospital internationally famous. 

Opportunity is here taken to express appreciation for the continued loyalty of 
the hospital personnel, and to thank the Medical Director, Board of Trustees and 
the State Department of Mental Diseases for encouragement and support. 

Respectfully submitted, 

ARTHUR M. BALL, 

Chief Executive Officer. 

REPORT OF THE SOCIAL SERVICE DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

Fortunately during the past year there have been very few changes in the 
personnel of the Social Service Department. On November 30, 1930 Mrs. Anne 
G. Beck, who had been with the department since June 25, 1929 resigned because 
of transferral to the Research Social Service Department. In March, 1931, her 
place was filled by Mrs. Ruth Kozol, a college graduate who had had partial training 
at the Simmons School of Social Work and at the McLean Hospital. The long 
delay in appointment was due as in previous years to the fact that there was no 
social service list available at the Department of Civil Service. An examination 
had been given in November but because of the large number of competitors a list 
could not be compiled for several months. 



P.D. 137 



29 



In September, 1931, Miss Alice Fellows and Miss Louise Silbert, students at the 
Smith College School for School Work, came to begin their nine months of field 
training as partial fulfillment for their degree of Master of Science. 

On December 1, 1930, the social service group working under the special research 
Fund on the study of pre-psychotic personalities, changed somewhat in personnel 
and in distribution of time. Miss Harriet Parsons, who had been with the group 
for two years resigned, her place being taken by Mrs. Beck, mentioned previously. 
Miss Louise V^eo, a graduate of the Smith College School for Social Work, who had 
trained at the Boston Psychopathic Hospital was added to the staff on a full-time 
basis. Having received the Master of Arts degree in the fall of 1930, Miss Zitha 
Rosen and Miss Grace Finn-Brown who had been with the research group for two 
years were able to give full-time to the purposes of the research. A few months 
later Miss Barbara Ashenden resigned and there were no additional appointments 
made. During the year emphasis was placed on the study of the influence on the 
psychosis of environmental factors. Such questions as the effect upon the patient 
of having to live in an alien religious group, or an alien color group, or an alien 
moral group, of having employment which was disagreeable and arduous, were 
discussed, analyzed and arranged for coding. These problems were found to be 
extremely difficult to evaluate as, for instance, it was hard to distinguish whether 
the job itself was the cause of the breakdown or whether it was the patient's re- 
action to it. Would another person in the same situation find the job distasteful, 
uncongenial, upsetting? Attention also was paid to the effect on the psychosis of 
an acute environmental stress such as a bereavement, financial disaster, being 
jilted. Are such situations more disturbing than chronic environmental strain 
such as marital maladjustment, proverty, etc.? As the code sheet of the environ- 
mental factors has been prepared only within the last few months there is no report 
available at present as to the results. Although depleted in personnel the research 
group will continue for a year longer and may then have some material to publish. 

As a result of the few changes in the staff of the regular department, the routine 
work has been handled fairly adequately, although it is always impossible for the 
small department to handle all the cases known to the hospital and the out-patient 
department. Instead of assigning cases on rotating basis as is the custom of the 
medical staff it has been found that the volume of work is increased by assigning 
certain duties and types of cases to certain workers who have developed special 
skill in the handling of their particular tasks. One worker is in charge of the ad- 
mission desk of the out-patient department. While she does not have time for 
much intensive case work she comes in contact with all of the patients who come 
to the out-patient department and because of her training is able to sense social 
problems which are handled either by other members of the social service depart- 
ment or sent to other agencies. Another worker spends her time in the clinic for 
the neurosyphilitic cases and carries on home visiting and treatment for a selected 
group. A third worker is in charge of the cases sent by the courts of metropolitan 
Boston for psychiatric study before trial or before sentence. The other two regular 
workers and the students have been carrying rather small case loads, spending a 
good deal of time intensively on a few cases. One worker has been much interested 
in the psychiatric social problems occurring in mother-adolescent daughter situa- 
tions, where there have been many conflicts over the social behavior of the daughter 
which conflicts with the mother's idea of correct conduct. The other has concen- 
trated on the difficulties which children of normal intelligence have when they have 
a special reading disability. She has even spent time on the tutoring of the children. 
Such procedure may seem foreign to the regular duties of the psychiatric social 
worker but in each instance it has seemed the best way to restore to the child a 
feeling of security and confidence in himself. 

C.H., a boy of 8, with an Intelligence Quotient of 110 had had difficulty 
in reading for three years. At school he was considered as "a bad one who 
would not learn and who deliberately caused mischief." Cutside of school 
on the playground he was a leader. He was particularly humiliated when he 
had to read orally in class and lost some of the prestige he had gained outside 
of school. His family also were ashamed of his poor scholarship. Through 
tutoring as well as case work with the family the social worker was able to 



30 



P.D. 137 



save his sense of failure by enabling him to read more smoothly. By spending 
time on special instruction she was able to show the family that he was worthy 
of special attention. In addition, she demonstrated to the teacher the close 
relationship between academic maladjustment and misbehavior. 
Year by year the number of cases sent by the courts to this hospital has increased. 
Many are difficult to diagnose and require careful investigation. Even though 
several days are spent on each case the worker frequently feels that her knowledge 
of the case is incomplete, that she has had little opportunity to reconstruct the life 
picture of the patient. Ideally she should have as much tim.e to spend on each 
case as the research group has found necessary, namely at least a week, but unless 
the social service staff is increased greatly in personnel such is impossible. Again 
there are not enough workers to supervise cases after discharge. Even though the 
patient is found to be non-psychotic he has been maladjusting socially or he would 
not have been arrested. The knowledge gained during his hospital residence of 
the forces which lie back of the arrest comes to naught if it cannot be used to help 
the patient to adjust after discharge. The Assault and Battery cases illustrate 
well the above point. Seldom is the patient found to be suffering from a psychosis 
but a complicated marital situation is unearthed which has been existing for many 
years, which has its roots deep in the sexual incompatibility of the patient and his 
or her mate, demonstrated overtly by much quarrelling, nagging, disputing, drink- 
ing, non-support, etc. The home atmosphere is extremely bad for the children. 
Unwilling to live apart, as neither wishes to give up the children and does not con- 
sider the other a fitting guardian for the children, the adjustment has to be made in 
the home. While few of these cases can be solved adequately the tension is lessened 
when there is intensive supervision over a long period of time. 

Frequently on return to court the case is dismissed and the defendant found not 
guilty. Then there is no one to supervise unless it is the psychiatric social worker. 
During the last year the social service department was able to superivse a few such 
cases, the nature of which is illustrated by the following record. 

P.C., a woman of 30, was sent to the hospital by the court following arrest 
on the charge of forgery. When the case came to trail it was discovered that 
the patient's adoptive mother was the complainant. She accused the patient 
of signing her name to checks. As the patient had been in the hospital once 
before because of ' nervous indigestion" she was returned to the hospital by 
the court for observation. Investigation showed that the mother believed 
the patient guilty because she herself had received messages through the air 
testifying against the patient. Psychiatric examination indicated that the 
patient was not psychotic and of normal intelligence. She had been under 
the complete dominance of her mother since early childhood, could never 
remain out of the house after eight o'clock at night without the mother com- 
plaining to the police. During the last two years however, patient had become 
disillusioned and more rebellious. She refused to accede to all her mother's 
demands. The latter had consequently become angry with her and even 
though the patient had always conducted the business of the family saw fit 
to bring the charge of forgery against her. The patient was returned to court 
as capable of standing trial. 

In addition to the formal report sent by the hospital the social worker was 
present to give information regarding the adoptive mother's oddities. As a 
result the court sent the mother to the hospital for examination and continued 
the case of the patient. The mother was found psychotic because for many 
years she had believed that people wished evil thoughts upon her, causing 
pains in various parts of her body. She also had received spirit messages. She 
was not committed because from the point of view of committing physicians 
she was able to live in the community. 

When the case came to trial again the mother withdrew her complaint 
against her daughter and the case was dismissed. 

As there was no probation officer to supervise the patient and as it seemed 
inadvisable for the patient and her mother to continue living together the case 
was placed under the supervision of the social worker who had been present 
throughout the court trials. As the patient had so long been under the will 



P.D. 137 



31 



of her mother she was found to be very childish and submissive with little 
ability to think independently. The social worker was in daily contact with 
her for a number of weeks until gradually patient became more independent, 
was able to find board and room for herself and a small job. 
At this time of unemployment and industrial depression social workers are 
asked constantly whether their case loads have increased in number and whether 
there has been any marked effect upon the client's personality. In this agency 
there seems to have been no appreciable increase in the admission rate in the out- 
patient department and the hospital but there have been a great number of strains 
and tensions in the family situations. Cases which have come to the clinic as 
problem children have proven difficult from a treatment angle because of the fact 
that the father is out of work and for the first time has needed relief. He does 
not understand the regulations of welfare departments and the apparent cold- 
heartedness of the dispensation of relief and needs the sympathic help of the 
psychiatric worker in adjusting to his new problems. Money alone does not seem 
all that he needs. Child placement agencies are unable to place problem children 
during the rehabilitation period of the parents unless the parents are able to aid 
financially. 

Perhaps the greatest need has been that of a number of women between twenty 
and thirty years of age who, trained for clerical work, can now find only temporary 
housework. The adjustment to ''living in", longer hours, the fear of losing the 
position have created attitudes which can be helped only through a great deal of 
counsel and psychiatric aid. 

The co-operative service with the agencies still continues. Last year the social 
service department presented to the supervisors of the Family Welfare Society 
two cases which were discussed by Dr. Ives Hendrick. psycho-analyst. The head 
social worker conducted a round table for the Division of Children's Workers 
under the Staff Council on the psychiatric social implications of illegitimacy. 

During the past year small sums of money which had been received as fees by 
a Fellow who had analyzed several patients w^ere given to the department and used 
in some of the following ways. A girl of 11, a case of persistent enuresis and car- 
sickness, who was scolded constantly by her family because of her flaws was given 
roller skates so that she might receive attention from her playmates and gain back 
some of the self-confidence which she had lost. A trumpet was rented for a feeble- 
minded boy so that he would not spend so much time playing with undesirable 
boys and also that he might play in the school orchestra and gain recognition which 
he could not obtain in his academic work. Several other patients were sent to 
camps and rest homes. 

At this time I should like to express appreciation of the excellent co-operation 
given this department by all members of the staff and especially the retiring 
Executive Officer, Dr. Arthur Ball. 

Respectfully submitted, 

ESTHER C. COOK, 

Head Social Worker. 

PUBLICATIONS 

A Study of One Hundred Cases Discharged "Against Advice ' from the Boston 
Psychopathic Hospital. Jacob Kasanin, M.D. and Esther C. Cook. Mental 
Hygiene, Vol. XV, No. 1, January, 1931, pp. 155-171. 

Ways of Meeting Resistance. Esther C. Cook. The Social Worker, October, 1930. 

SOCIAL SERVICE STATISTICS 
1. Numerical Summary: 





Male 


Female 


Totals 




Children 


Adults 


Children Adults 




New cases .... 


. 160 


292 


82 


240 


774 


Renewed from previous year 


. 30 


13 


11 


16 


70 


Continued from previous year 


18 


33 


17 


26 


94 


Total carried during year 


. 208 


338 


110 


282 


938 



32 



P.D. 137 



Closed during year . . .178 320 90 247 835 

Continued to following year . 30 18 20 35 103 

II. Sources of New Cases: 

House 337 

Out-Patient Department . 229 

Research 121 

School Survey 87 

Sources of Continued Cases: 

House 39 

Out-Patient 45 

Research 10 

Sources of Renewed Cases: 

House 16 

Out-Patient 37 

Research 9 

School Survey 8 

III. Analysis of Work on All Cases: 

Number of histories 213 

Number of investigations 252 

Number of patients on visit from hospital books .... 101 
Patients visited by Social Service: 

On visit (exclusive of Syphilis Service) 17 

All others (including House cases which have been discharged 

into the Community and Out-Patient cases) . 360 
Number of visits pertaining to the supervision of patients in 
the community, either ex-House cases or Out-Patient cases 
(does not include visits made during course of investigation) 803 

Number of visits to patients on wards 301 

Placements by Social Service: 

1. Unable to place 40 

2. Number placed 37 

Unclassified 86 

IV. Outstanding Social Problems: 

Diseases: 

Mental 415 

Physical 148 

Personality, problems, including temperament, vacillating interests, 

instability, etc 306 

Legal problems, including larceny, assault, forgery, etc. . . 128 

Sex problems 114 

Environmental: 

Financial difficulties 158 

Employment 97 

Marital difficulties 95 

Unsuitable surroundings, broken home, friction in the home, in- 
adequate physical surroundings, immoral parents . 247 
V. Miscellaneous: 

Expense account $535 66 

SOCIAL SERVICE STAFF 
Head Social Worker: Esther C. Cook, July 1, 1928. 

Assistants in Social Service: Anne G. Beck, June 25, 1929 — resigned November 



29, 1930; Rena Dewey, August 25, 1930; Ruth Kozol, March 25, 1931; Annie 
Porter, October 13, 1930; Clara Swain, October 1, 1930. 

Syphilis Folloic-up Worker: Ruth Epstein, September 30, 1930. 



PD. 137 



33 



REPORT OF THE PRINCIPAL OF THE SCHOOL OF NURSING 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith present the annual report of the nursing department for the year 
ending November 30, 193L 

On nursing service — Principal of the School of Nursing, 1; Assistant Principal 
of the School of Nursing, 1; nurse instructor (full time), 1; female supervisor 
(night,),!; male supervisor (day ), 1 ; assistant supervisors, 2; head nurse, opei*ating 
room, 1; head nurses, wards, 7; assistant head nurses, 2; student nurses, 14; 
hydrotherapists, 2; female attendants. 8; male attendants, 14. 

Head nurses resigned — Miss Margaret de Grouchey and Miss Helen Brougham. 

Head nurses appointed: — Miss Ann Pease, a graduate of the Winchester Hospital 
and Miss Elizabeth Higgins a graduate of Newton Hospital. These nurses have 
taken the affiliated course here. 

During the year we received 57 student nurses and 1 graudate nurse for the 
three months course in psychiatric nursing. 

Special ?iursing — Number of special nurses, 13. Total number of weeks in 
wards, 26. 

Miss Marion Jones a graduate of the Ellis Hospital, Schenectady, New York, 
completed a three months post-graduate course here and later accepted a position 
as head nurse, while Miss Olia Butler was on a leave of absence due to illness. 

Mr. Thomas McHugh, male nurse in charge of Ward A took a course in electro- 
therapy at Worcester State Hospital and has assisted in giving 130 diathermy 
treatments to our neuro-syphilis patients. 

Hydrotherapy: tonic baths, patients 220; foot baths, 542; salt glows, 783; 
electirc light baths, 492; sitz baths, 216; saline baths, 165; hot and cold to the 
spine, 143; tub shampoos, 557; hair shampoos, 470; needle sprays, 3,041; fan 
douches, 3,041; jet douches, 1,005; rain douches, 481; scotch douches, 51. Con- 
tinuous baths: No. of patients, 329; Number of baths, 1,448; Number of hours, 
8,923. Wet sheet packs: Number of patients, 38: number of packs, 61 ; number 
of hours, 153 ' 2- Instruction in wet sheet packs, continuous baths and tonic baths 
was given to 57 student nurses. Number of lessons 951; number of hours, 951. 
Instructions in wet sheet packs was given to 21 male attendants. Number of 
lessons, 63; number of hours, 63. 

There has been a marked increase in the number of physically sick patients 
admitted to the hospital during the present year, which has taxed the nursing staff 
to the utmost. A great many of these patients during the acute illness had to be 
specialed by student nurses. Again I must emphasize the need of a nurses home, 
which would enable us to accept more student nurses, and the problem of caring 
for these patients could be met in a more satisfactory manner, with little expense 
to the hospital, as some of the student nurses receive no salary. 

We discontinued affiliation with the Winchester Hospital in November and 
started an affiliation with the Lynn Hospital. We have also accepted two more 
student nurses from the Faulkner Hospital. 

We have added ten hours of psychology (mental adjustments) to the nursing 
curriculum. We are indebted to Dr. F. L. Wells for this contribution to our 
lecture course. 

I wish to thank the Director and executive staffs for their encouragement and 
kindly support, the medical staff for the splendid spirit shown in giving so much 
of their time in lectures to the student nurses, and all the employees on the nursing 
service for their co-operation and loyalty. 

Respectfully submitted, 

MARY FITZGERALD, R. N., 

Principal of the School of Nursing. 



34 



P.D. 137< 



REPORT OF THE DEPARTMENT OF OCCUPATIONAL THERAPY 
To the Director of the Bosto7i Psychopathic Hospital: 

During the year the Occupational Therapy Department has carried on its usual 
activities, providing work for all house patients who are able to come to the work! 
rooms, where as far as possible, each is given work to suit his individual need. 
With the short term patient, the most that we can hope to accomplish is the 
establishment of confidence and of a realization of his relationship to the routine 
of the hospital. It is with the long term patient that we can work out a more 
constructive program. 

For several months in the year, we have with us students from the Boston School 
of Occupational Therapy, who receive part of their training with mental patientsi 
in this department, and it is while they are with us, that more regular and specialized! 
work is possible with the patients on Ward 3, under the supervision of the assistant. 
From the therapeutic point of view this first contact with the patients is mosti 
valuable and if they are later brought to the work rooms, makes for a more co- 
operative attitude. 

We have also continued to give a short period of training to the affiliated nurses. 
This is necessarily brief but we try to give them some insight into the rudiments 
of the work. 

The recreational side of our program has taken the form of holiday dances iiii 
the Assembly Hall and informal parties in the Sun Room of the Department, atl 
some of which moving pictures have been shown. 

This report would certainly be incomplete if it failed to pay tribute to the long 
and faithful service and highly skillful management of its former head. Miss 
Ethelwyn F. Humphrey, whose resignation and marriage took place in the summer. 
On the marriage of her assistant Miss Dorothy Hayden, the personnel of the De- 
partment entirely changed. 

Since their departure, Miss Elizabeth Gustafson a graduate of the Boston 
School of Occupational Therapy in June served as a temporary assistant for seven 
weeks followed by Miss Genevieve Maynard, a graduate of the Boston School in 
1930 and with a year's experience in the Boston State Hospital. 
The statistics of the Department are as follows: 

Attendance — Women — average attendance, 20; total enrollment, 609. 
Attendance — Men — average attendance, 19; total enrollment, 617. 
Articles made, 1,584. forms printed, 18,425. 

Respectfully submitted, 

ALICE E. WAITE, 

Head Occupational Therapist. 

PUBLICATIONS FROM THE CLINICAL SERVICE AND LABORATORIES 
Beck, S. J. — Personality Diagnosis by Means of the Rorschach Test. American 

Journal of Orthopsychiatry, Vol. 1, No. 1, 81-88, 1930. 
Beck, S. J. — The Rorschach Test in Problem Children. American Journal of 

Orthopsychiatry, Vol. 1, No. 5, 501-511, 1931. 
Beck, S. J. and Levy, D. M. — The Rorschach Test in Manic-Depressive Psychosis 

Manic-Depressive Psychosis. Vol. XI, Pp. 167-181, Research Publications, 

Association for Research in Nervous and Mental Disease, 1931. 
Bowman, K. M. and Raymoxd, A. — A Statistical Study of the Personality in 

Schizophrenic Patients. Schizophrenia, Chapter V, P. 48. Vol. X, Association 

for Research in Nervous and Mental Disease. Williams & Wilkins Co., Baltimore, 

1931. 

Bowman, K. M. — The Industrial Aspects of Morbid Emotion and Fatigue. 
Preventive Management, Chapter VI, Pp. 145. B. C. Forbes Publishing 
Co., N. Y. 

Bowman, K. M. — Personal Problems for Men and Women. Greenberg, N. Y. 
1931. Pp. 279. 

Bowman, K. M. and Raymond, A. — A Statistical Study of Delusions in the 
Manic-Depressive Psychoses. Manic-Depressive Psychosis, Chapter XVIII, 
Pp. 313. Vol. XI, Association for Research in Nervous and Mental Disease. 
William & Wilkins Co., Baltimore, 1931. Also in American Journal of Psychiatry. 



P.D. 137 35 

Bowman, K. M. and Raymond, A. — A Statistical Study of Hallucinations in the 
Manic-Depressive Psychoses. American Journal of Psychiatry, Vol. XI, No. 2, 
Sept. 1931. Vol. XI, No. 1, July 1931. 

Bowman, K. M. — The Overtired Parent. The Parents Magazine, Vol. VI, No. 
2, P. 22. February 1931. 

Campbell, C. Macfie — The Training of the Specialist in Psychiatry. Proceed- 
ings, Congress on Medical Education, Medical Licensure and Hospitals, Chicago, 
February, 1931. 

Campbell, C. Macfie — Psychology and Biography. American Journal of 
Psychiatry, Vol. X, No. 5, March, 1931. 

Campbell, C. Macfie — Observations on the Role of Environmental Factors in 
Schizophrenic Conditions. Proc. Ass. Res. Nerv. and Ment. Dis. 10:43-47, 1931. 

Sanborn, A. G. — The Fecal Flora of Adults, with Particular Attention to Indi- 
vidual Differences and Their Relationship to the Effects of Various Diets. The 
Journal of Infectious Diseases, Vol. 48, No. 6, Pp. 541-569, June, 1931. 

Sanborn, A. G. — The Fecal Flora of Adults, with Particular Attention to In- 
dividual Differences and Their Relationship to the Effects of Various Diets. 
The Journal of Infectious Diseases, Vol. 49, No. 1, Pp. 37-89, July, 1931. 

Solomon, H. C, Kaufman, M. R. and d'Elseaux, F. — Some Effects of In- 
halation of Carbon Dioxide and Oxygen, and of Intravenous Sodium Amytal on 
Certain Neuropsychiatric Conditions. Am. J. Psychiat. 10:761-769, March, 1931. 

Solomon, H. C. and Klauder J. V. — Trauma and Dementia Paralytica. J. A. 
M. A. 96:1-7, Jan. 3, 1931. 

Solomon, H. C. and Epstein, S. H. — Tryparsamide in the Treatment of Neuro- 
syphilis. New York State Journal of Medicine, August 15, 1931. 

Wells, F. L. — Comparative Psychology and Mental Hygiene. American Journal 
of Orthopsychiatry, 1931, Vol. 1, No. 4, 400-405. 

Wells, F. L. — Review of "Culture and Progress" by W. D. Wallis. Journal of 
Philosophy, 1931, Vol. 28, No. 20, 550-555. 

VALUATION 

November 30, 1931 
Real Estate 

Land. 2 acres $59,300.00 

Buildings 541.944.28 

$601,244.28 

Personal Property 

Travel, transportation and office expenses $3,801 . 18 

Food 1.903.66 

Clothing and materials 1.751.69 

Furnishings and household supplies 24,362.93 

Medical and general care 20.599 . 88 

Heat, light and power 897 . 57 

Farm 

Garage, stables and grounds 137.40 

Repairs 1.357.43 

$54,811.74 

StTMMARY 

Real estate $601,244.28 

Personal property 54.811.74 

$656,056 02 

FINANCIAL REPORT 
To the Department of Mental Diseases: 

I respectfully submit the following report of the finances of this institution for 
the fiscal year ending November 30, 1931. 

Cash Account 
liecfipta 

Income 

Board of Patients $10,354.57 

Reimbursements . , 2.125 63 

o ,^ . $12,480.20 

Personal Servuis: 

ReimbursennMU from Hoard of Rctirt iiH iu Oj 75 
Sales: 

Travel, transfxirtation and office expen^< - 9.50 

Food 67.12 

Furnishings and household supplies . 6.00 



36 P.D. 137 

Repairs, ordinary 14.52 

Arts and crafts sales . . 64.38 

Total Sales . 161.52 

Miscellaneous: 

Interest on bank balances S163.85 

Rent 1,800.00 

Sundries .... 238.25 

2,202.10 

Total Income $14,937.58 

M.\INTEX.\XCE 

Balance from previous year, brought forward $6,327.36 

Appropriations, current year: 253,100.00 

Total $259,427.26 

Expenses (as analyzed below) 245,474.52 

Balance reverting to Treasury of Commonwealth $13,952. 74 

Analysis of Expenses 

Personal services $162,090.20 

Religious instruction 1,790.00 

Travel, transportation and office expenses 5,828 66 

Food 30,850.54 

Clothing and materials 1,125 .41 

Furnishings and household supplies 5,023.57 

Medical and general care 17,801.23 

Heat, light and power 9,739.67 

Garage, stable and grounds 288 . 60 

Repairs ordinary 3,784.62 

Repairs and renewal? 7,152.02 

Total expenses for Maintenance $245,474.52 

Per Capita 

During the year the average number of inmates has been. 83.80. 
Total cost of maintenance. $245,474.52. 
Equal to a weekly per capita cost of $56.3325. 
Receipt from sales. $161.52. 
Equal to a weekly per capita of $.0370. 
All other institution receipts, $14,776.06. 
Equal to a weekly per capita of $3.3908. 
Net weekly per capita of $52.90. 

Respectfully submitted, 

ELIZABETH LIBBER SHORE, 

Treasurei . 

STATISTICAL TABLES 

As Adopted by the American Psychiatric Association 
Prescribed by the Massachusetts Department of Mental Diseases 

Table L General [ :ifor /nation 

Data correct at end of hospital year November 30, 1931 

1. Date of opening as a hospital for mental diseases, June 1912. 

2. Type of hospital: State. 

3. Hospital plant: 

Value of hospital property: 

Real estate, including buildings $601,244.28 

Personal property 54,811.74 

Total $656,056.02 

Total acreage of hospital property owned, 2 acres. 

4. Officers and employees. November 30, 1931. 

Actually in Service Vacancies at End 

at End of Year of Year 

M. F. T. M. F. T. 

Superintendents 2 - 2 - - - 

Assistant physicians 6 1 7 1 - 1 

Medical internes 2 - 2 1 - 1 

Clinical assistants 5 1 6 1- 1 

Total physicians 15 2 17 3 - 3 

Stewards - - - - - - 

Resident dentists 1 - 1 - - - 

Pharnjacists - - - - 

Graduate nurses 2 12 14 - 2 2 

Other nurses and attendants ... 16 16 32 - 

Occupational therapists - 2 2 - 

Social workers. ... ... 6 6 - - - 

All other officers and employee.^ ... 43 23 66 2 2 4 

Total officers and employees ... 62 59 121 2 4 6 



P.D. 137 



37 



Note: — The following items, 5-10, inclusive, arc for the year ended September 30, 1931. > 
5. Census of Patient Population at end of year: 

Absent from Hospital 
Actually in Hospital but Still on Books 

White: M. F. T. M. F. T. 

Insane 30 26 56 37 19 56 



Epileptics - 2 2 - - - 

Mental defectives 2 1 3 - " 1 " 

All other cases 7 6 13 5 ^ 5 j 10 



Total 39 35 74 42 24 I 66 

Other Races: ' 

Insane 1 1 2 1 112 

Total 2 1 3 1 1 2 

Grand Total 41 36 77 43 25 | 68 

M. F. T. 

6. Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 25 12 37 

7. Other patients employed in general work of hospital on date of report 3 - 3 

8. Average daily number of all patients actually in hospital during year . 44 . 74 39 . 1 2 i 83 . 86 

9. Voluntary patients admitted during year 37 24 -61 

10. Persons given advice or treatment in out-patient clinics during year . 657 673 1,330 



Table 2. Financial Statement 
See Treasurer's report for data requested under this table. 



Note. — 



The following tables 3-18, inclusive, are for the Statistical year ended September 30, 1931. 



38 



P.D. 137 



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Table 4. Nativity of First Admissions and of Parents of Fjirst Admissions. 



Nativity 


Patients 


Parents of Male 
Patients 


Parents of Female 
Patients 


M. 


F. 


T. 


Fathers 


Both 
Mothers Parents 


Fathers 


Both 
Mothers Parents 


United States .... 


60 


54 


1 14 


29 


32 


28 


27 


22 


20 


Austria 




- 


- 


1 


1 


1 


1 




t 


Canada ' 


2 


5 




6 


6 


5 


10 


13 


9 


Denmark 


- 




- 


" 






- 






England 




1 


1 


1 


1 


1 


3 


4 


1 


France 




1 


1 








2 






Germany 








3 


3 


3 


4 






Greece 


1 




1 


1 


1 


1 








Holland 
















1 




Ireland ...... 


3 




3 


15 


12 


12 


9 


12 


9 


Italy 


1 


1 


2 


5 




5 


3 


3 


3 


Portugal 








1 


1 


1 








Russia 


5 


5 


10 


9 


9 


9 


7 


7 


7 


-Scotland 




1 


1 








1 


1 




.Sweden 




1 


1 








2 


2 


2 


West Indics = 








1 


1 


1 








Unascertained ... 


1 




1 


1 


1 


1 








Total 


73 


69 


142 


73 


73 


68 


69 


69 


54 



'Includes Newfoundland. 



- Except Cuba and Porto Rico. 



40 



P.D. 137 



o 



n > 
<u o 



1^ 



^ ir; I — « I fN 



I I 

'■ ^ i— 

— — 00!N'*-* I f^f^il 

-< I «N — <r> I {Nj I 

1 — >0 — — — I CN — I 



fT) (N I — I — 



lO f*) lO !N I »H I 1 



CO 



CSOOOOr-'0-OCS<*3r»2 



P.D. 137 



41 



Table 5. Citizenship of First- Admissions. 

Male Female Total 

Citizens by birth 60 54 114 

Citizens by naturalization 5 8 13 

Aliens 7 6 13 

Citizenship unascertained 1 1 2 

Total 73 69 142 



Table 6. Psychoses of First Admissions. 



13. 



Psychoses 



Traumatic psychoses 

Senile psychoses 

Psychoses with cerebral arteriosclerosis 

General paralysis 

Psychoses with cerebral syphilis . 
Psychoses with Huntington's chorea . 
Psychoses with brain tumor 

Psychoses with other brain or nervous diseases, total 

Other diseases 

Alcoholic psychoses, total .... 

Delirium tremens 

Acute hallucinosis 

Psychoses due to drugs and other exogenous toxins, to^tal 

Opium (and derivatives), cocaine, bromides, chloral, etc., 

combined 

Psychoses with pellagra 

Psychoses with other somatic diseases, total 

Delirium with infectious diseases 

Delirium of unknown origin 

Cardio-renal diseases .... 

Other diseases or conditions 
Manic-depressive psychoses, total 

Manic type 

Depressive type 

Involution melancholia .... 
Dementia praecox (schizophrenia) 
Paranoia and paranoid conditions 

Epileptic psychoses 

Psychoneuroses and neuroses, total 

Hysterical type 

Psychasthenic type (anxiety and obsessive forms) 
Psychoses with psychopathic personality . 
Psychoses with mental deficiency 
Undiagnosed psychoses .... 
Without psychosis, total .... 

Psychopathic personality without psychosis 

Total 



lone 



M. F. T. 



M. K 





1 


1 




1 




J'i 


1 1 


to 


1 


3 


4 


2 


- 


2 




1 


1 


1 


14 


15 


5 


7 


12 




2 


2 


18 


10 


28 


1 


3 


4 




3 


3 


1 


1 


2 


5 


12 


17 



73 69 H2 



42 P.D. 13 

Table 7. Race of First Admissions Classified zaitli Reference to Principal Psychose 





























With othei 
















With cerebral 


General 


brain or 


Race 




Totai 


Traumatic 


arterio- 




paralysis 


nervous 
















sclerosis 










diseases 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


M. 




T. 


M. 


F. T 


African (black) 


4 


1 


5 














1 




1 


- 




English 


13 


19 


32 


- 


- 


- 


1 




1 


7 


6 


13 




1 


Frencti 


5 


3 


8 










1 


1 


3 


2 


5 


1 




German 


- 


1 


1 
























Greek 


1 


















1 




1 






Hebrew 


13 




20 






1 








9 




9 






Irish .... 




15 


38 








2 




2 












Italian » 


5 


3 


8 














3 




3 






Portuguese .... 


1 




1 














1 




1 






Scandinavian- .... 




2 


2 






















1 


Scotch 




3 


3 
















1 


I 






Slavonic ' 






1 






















1 


MLxed 


8 


il 


19 








1 




1 


2 


2 


4 






Race unascertained . 






3 
























Total 


73 


69 


142 




1 


1 


4 


1 




34 


11 


45 


1 


3 



Table 7. Race of First Aamissions Classified with Reference to Principal 
Psychoses — Continued. 



R.\CE 



African (black) 
English . 
French . 
German . 
Greek 
Hebrew . 
Irish 

Italian ' . 
Portuguese 
Scandinavian 
Scotch 
Slavonic * 
Mixed 
Race unascertained 

Total 



Alcoholic 



M. F. T. 



Due to drugs 
and other 
exogenous 
toxins 



M. F. T. 
1 1 



With other 
somatic 
diseases 



M. F. T. 



1 1 



Manic- 
depressive 



M. F. T. 



1 1 2 

2 2 4 



Involutioni 
melancholij 



M. F. T. 



'Includes "North " and "South." 
-Norwegians, Danes and Swedes. 
'Includes Bohemian. Bosnian, Croatian, Dalmatian, Ilerzegovinian, Montenegrin, Moravian, Polisi: 
Russian, Ruthenian, Servian, Slovak, Slovenian. 



P.D. 137 



43 



Table 7. Race of Fht^f Admissions Classified with Reference to Principal 
Psychoses — Concluded. 



Race 


Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


Epileptic 
psychoses 


Psycho- 
neuroses 
and neuroses 


l"ndiagnosed 
psychoses 


Without 
psychoses 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


African (black) 
English . 
Frencii 
(iernian . 
Greek 
Hebrew 
Irish 
Italian ' 
Portuguese . 
Scandinavian - 
scotch 
Slavonic ' 
Mixed . 

Race iinascertained 


1 - 1 

2 2 4 
1 - 1 

1 1 2 
8 3 11 
1 - 1 

4 3 7 
1 1 


1 1 

— 11 
1 - 1 


-12 
1 1 


1 - 1 
1 1 


1 3 4 

1 1 2 

3 2 5 
t 1 

1 1 

I 1 

- 2 2 
1 1 


1 - 1 


Total 


18 10 28 


1 3 4 


- 3 3 


1 1 2 


5 12 17 


1 - 1 


•Includes "Xorth" and "South " 
'Xorvveyians. Danes and Swedes. 

'Includes Bohemian, Bosnian, Croatian, Dalmatian, Herzcgovinian, Montenegrin, Moraviiui. Polish. 
Russian, Ruthenian, Servian, Slovak, Slovenian. 


Fable 8. Age of First Admissio7is Classified with Reference to Principal Psychoses. 













Under 15 




15-19 




20-24 




25-29 




Psychoses 




Tota 


1 


years 




years 






years 






years 






M. 




F. 


T. 


.M. F. 


T. 


M. 


F. 


T. 


M 


F. 


T. 


M 


F. T. 


1. 


Traumatic 


























































3. 


VVith cerebral arteriosclerosis 


4 




5 






















4. 


General paralysis .... 


34 


11 


45 


- 1 


1 










1 


1 






5. 


With cerebral syphilis . 




























6. 


With Huntington's chorea . 




























I: 


With brain tumor. 






























With other brain or nervous 






























diseases 


1 


3 


4 








2 


2 












9. 


Alcoholic 


2 




2 






















10. 


Due todrugsand other exogenous 


































1 


1 




















1 1 


11. 


With pellagra .... 




























12. 


Withother somaticdiseases 


1 


14 


15 














3 


3 




3 3 


13. 




S 


7 


12 






2 


2 


4 










1 1 


14. 


Involution melancholia 




2 


2 






















I.S. 


Dementia praecox 


18 


10 


28 






4 


3 


7 


6 


4 


10 


3 


2 5 


16. 


Paranoia and paranoid conditions 


1 


3 


4 






















17. 


ICnileptic psychoses 




3 


3 






















18. 


Psychoneuroses and neuroses 


1 


1 


2 












1 




1 




1 1 


19. 


With psychopathic jxirsonality . 




























•0. 


With mental deficiency 




























!1. 


Undiagnosed psychoses 


.S 


12 


17 


- 1 


1 


1 




1 


1 


2 


3 


1 


2 3 


!2. 


Without psychosis 






1 










1 














Total 


73 


69 


142 


- 2 


2 


8 


10 


18 


8 


10 


18 


5 


10 15 



44 



P.D. 13' 



Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses — Continued. 









30-34 






35-39 






40—44 






45—49 






Psychoses 




years 






years 






years 






years 








M. 


F. 


T. 


M. 


p. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 




Traumatic 






















1 




2. 


Senile 


























3. 


With cerebral arteriosclerosis 


























4. 


General paralvsis 


5 


1 


■J 


5 


1 


7 


5 


1 




7 


2 


9 


5. 


With cerebral svphilis 


























6. 


With Huntington's chorea .... 


























7. 


With brain tumor 


























8. 


With other brain or nervous diseases 






















1 


1 


9. 


Alcoholic 














1 




< 


1 




1 


10. 


Due to drugs and other exogenous toxins 


























11. 


With pellagra 


























12. 


With other somatic diseases. 


1 


2 


3 


- 


3 


3 


- 


1 


1 


- 


1 


1 


13. 




1 


2 


3 




2 


2 








1 




1 


14. 


















1 






1 




15. 


Dementia praecox 


2 


1 


3 


1 




1 








I 




1 


16. 


Paranoia and paranoid conditions 




2 


2 








1 












17. 




























18. 


Psychoneuroses and neuroses 


























19. 


With psychopathic personality 


























20. 




























21. 


Undiagnosed psi choses 


1 


2 


3 




1 


1 


1 


2 


3 








22. 


Without psychosis 




























Total 


11 


10 


21 




7 


14 


9 


5 


14 


10 


6 


16 



Table 8, Age of First Admissions Classified with Reference to Principal 
Psychoses — Concluded. 









50-54 






55-59 






60-64 




70 years 




Psychoses 




years 






years 






years 




and over 






M. 


F. 


T. 


M. 


F. 


T. 


M 


F. 


T. 


M. F. T. 


1. 


Traumatic 






















2. 


Senile 






















3. 


With cerebral arteriosclerosis 


2 




2 


1 




1 


1 




1 


1 1 


4. 


General paralysis 


4 


2 


6 


4 


1 


5 


1 


1 


2 




5. 
























6. 


With Huntington's chorea .... 






















7. 


With brain tumor 






















8. 


With other brain or nervous diseases. 






















9. 


Alcoholic 






















10. 


Due to drugs and other exogenous toxins 






















11. 


With pellagra 






















12. 


With other somatic diseases. 
















1 


1 




13. 


Manic-depressive 


1 




1 
















14. 


Involution melancholia .... 






















15. 




1 




1 
















16. 


Paranoia and paranoid conditions 










1 


1 










17. 


Epileptic psychoses 






















18. 


Psychoneuorses and neuroses 






















19. 


With psychopathic personality . 






















20. 


With mental deficiency 






















21. 


Undiagnosed psychoses 










1 


1 




1 


1 




22. 


Without psychosis 
























Total 


8 


2 


10 


5 


3 


8 


2 


3 


5 


1 1 



P.D. 137 



45 



V 


H ' 


1 — 1 


1 ! 1 1 1 


1 1 - 1 "TtN 1 1 1 


1 — 1 




rolleg 


til ' 


1 1 1 1 


1 1 1 1 1 


1 1 — 1 — <N 1 1 1 


1 1 1 






S ' 


1 1 


,,,,, 


1 1 1 1 'O 1 1 1 1 


1 — 1 






H ' 






1 X^. r — : — 








' 

S ' 


1 1 fN 1 
1 —On 1 


1 — 1 

1 1 1 1 


1 <N — o — 1 1 1 

1 — f*) \ X : 1 — 1 


1 t 1 
1 


25 25 




H ' 


1 (S W i 


1 <N -H 1 


1 « O ^ O — 'N — 1 




o 


School 


u; ' 
i ' 


1 1 X 1 

1 O 1 


1 — 1 1 


1 O f*! 1 <N — 1 
1 1 — 1 1 1 


1 t» 1 

1 1 


rn 


•a 

c - 




1 «N 1 


1 — 1 


1 1 1 1 1 — 1 1 




o 


Reads j 
writci 


£=; ' 
s ' 


1 — 1 
11-1 


1 - 1 1 
1 1 - 1 


1 1 1 1 ! — 1 1 
1 < , . , . 1 . 


1 1 1 


"* 


OJ 




1 1 1 1 


1 1 1 1 




1 — 1 




2 




. . . , 


,11. 


1 1 1 1 1 1 1 


1 - 1 


f*5 










1 1 1 1 1 1 1 1 


1 1 




_ 




1 IT 1 


1 1- ^ — 


ir: !^ fN X ^ 1 






Tola 






1 1 — 


'S' rs o — 1 


1 rN 1 








1 1 1 




— I/: 1 X — 1 — 1 






X 

u 







UOI1 




"O 




c 

• 
u 


lia 




o 





8^ 



I ^ (5 If is ^ ^ ^ Q ^ :^ i r5 £^ £ is -5 :! 



46 P.D. IS- 



Table 10. Environment of First Admissions Classified with Reference to Principa 

Psychoses \ 



Psychoses 




_ 

1 Ota 


[ 


Urban 


Kural 








p 


T 


M. 


F. 


T. 


M. F. T. 


1. 










_ 


1 


1 




2. 


















3. 








5 


4 


1 


5 




4. 


General paralysis 


34 




45 


34 


11 


45 




5. 


With cerebral syphilis 
















6. 


















7. 


















8. 






3 




1 


3 


4 




9. 




2 




2 


2 


- 


2 




10. 


Due to drugs and other exogenous toxins .... 




I 


1^ 




1 


1 




11. 


















12. 




J 


14 


15 


1 


14 


15 




13. 






7 


12 


5 




12 


_ _ _ 


14. 






2 


2 




2 


2 




15. 




18 


10 


28 


18 


10 


28 




16. 




1 


3 


4 


1 


2 


3 


- 1 1 


17. 






3 


3 




3 


3 




18. 




1 


1 


2 


1 


1 


2 




19. 


With psychopathic personality 
















20. 


















21. 




5 


12 


17 


5 


12 


17 




22. 


Without psychosis 


1 




1 


1 




1 






Total 


73 


69 


142 


73 


68 


141 


- 1 1 



Table 11. Economic Condition of First Admissions Classified with Reference t( 

Principal Psychoses 



Psychoses 




Tota 


1 


Dependent 


Marginal 






M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 








1 


1 










1 




2. 


Senile . . . 




















3. 




4 


1 


5 








4 


1 


5 


4. 


General paralysis 


34 


11 


45 








34 


11 


45 


5. 






















6. 


With Huntington's chorea 










































8'. 


With other brain or nervous diseases .... 


1 


3 


4 








1 


3 


4 


9. 


Alcoholic 


2 




2 








2 




2 


10. 


Due to drugs and other exogenous toxins . 




1 


1 










1 


1 


11. 






















12. 




1 


14 


15 








1 


14 


15 


13. 




5 


7 


12 








5 


7 


12 


14. 






2 


2 










2 


2 


15. 




18 


10 


28 








18 


10 


28 


16. 


Paranoia and paranoid conditions .... 


1 


3 


4 








1 


3 


4 


17. 






3 


3 




1 


1 




2 


2 


18. 


Psychoneuroses and neuroses 


1 


1 


2 








1 


1 


2 


19. 






















20. 






















21. 


Undiagnosed psychoses 


5 


12 


17 








5 


12 


17 


22. 




1 




1 








1 




1 




Total 


73 


69 


142 




1 


1 


73 


68 


141 



P.D. 137 47 



Table 12. Use of Alcohol by First Admissions Classified with Reference to Principal 

Psychoses 























Intem- 


Unascer- 


Psychoses 








Tota 


1 


Abstinent 


Temperate 


perate 


tained 








M. 




F. 




T. 


M. F. T. 


M. F. T. 


M.F. T. 


M. F. T. 


1. Traumatic 








1 


1 




1 1 










2. Senile 
























3. With cerebral arteriosclerosis 


4 


1 


5 


2-2 


2 1 3 






4. General paralysis . 






34 


11 


45 


11 8 19 


19 2 21 


3 1 4 


1 - 1 


5. With cerebral syphilis 
























6. With Huntington's chorea . 






















7. With brain tumor 
























8. With other brain or nervous dis- 


























1 


3 


4 




- 3 3 




1 


_ _ _ 


^ — — 


9. Alcoholic 






2 


_ 


2 










2-2 


_ _ _ 


10. Due to drugs and other exogenous 




















toxins 






_ 


1 


1 




1 1 










11. With pellagra 
























12. With other somatic diseases 




1 


14 


15 






1 4 5 


- 1 1 


- 2 2 










7 


12 


3 6 9 


2 1 3 






14. Involution melancholia 








2 


2 




2 2 










15. Dementia praecox 






1 8 


10 


28 


12 9 21 


5-5 


1 — 1 


— 1 1 


16. Paranoia and paranoid conditions 


1 


3 


4 


1 3 4 










17. Epileptic psychoses 








^ 


3 




- 3 3 










1 8. Psychoneuroses and neuroses 


1 


1 


2 


1 1 2 










19. With psychopathic personality . 




















20. With mental deficiency 
























21. Undiagnosed psychoses 






5 


12 


17 


3 11 14 




- 1 1 


2-2 




22. Without psychoses 






1 




1 




1 










Total 






73 


69 


142 


34 55 89 


30 9 39 


8 2 10 


1 3 4 


Pable 13. Marital Condition of First Adynissions Classified 


luith Reference to 








Princij^al Psychoses 










Psychoses 




Tota 


1 


Singie 


Married 


Widowed 


Separated 


Divorced 




M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M.F. T. 


M. F. T. 


M. F. T. 


1. Traumatic . 




1 


1 








1 


1 








2. Senile .... 
























3. With cerebral arterio- 
























sclerosis . 


4 


1 


5 








3 1 


4 






1 - 1 


4. General paralysis 


34 


11 


45 


9 


4 


13 


22 5 27 


2 1 3 




1 1 2 


5. With cerebral syphilis 
























6. WithHuntington'scho- 
























rea .... 
























7. With brain tumor 
























8. With other brain or 
























nervous diseases 


1 


3 


4 




3 


3 


1 


1 








9. Alcoholic 


2 




2 








1 


1 




1 - 1 




10. Due to drugs and other 
























exogenous toxins 




1 


1 








1 


1 








11. With pellagra 
























12. With other .somatic 
























diseases . 


1 


14 


15 




1 


1 


- 11 11 


1 2 3 






[3. Manic-depressive 


5 


7 


12 


3 


2 


5 


1 5 


6 






1 - 1 


14. Involution melancholia 




2 


2 




1 


1 


1 


1 








15. Dementia praecox 


18 


10 


28 


16 


8 24 


2 1 


3 




- 1 1 




16. Paranoia and paranoid 
























conditions 


1 


3 


4 


1 


3 


4 












17. Epileptic psychoses . 




3 


3 


















18. Psychoneuroses and 
























neuroses . 


1 


1 


2 


1 


1 


2 












19. With psychopathic per- 
























sonaUty . 
























?0. With mental deficiency 
























!1. Undiagnosed psycho.ses 


5 


12 


17 


3 


9 12 


2 3 


5 








12. Without psychosis 


1 




1 


1 




1 












Total . 


73 


69 


142 


34 


35 69 


32 29 61- 


3 3 6 


1 1 2 


3 1 4 



48 P.D. 137 
Table 14. Psijchoses of Readmissions 

Psychoses Males Females Total 

General paralysis 2 - 2 

Alcoholic psychoses 1 - 1 

Mahic-depressive psychoses 1 1 2 

Total 4 1 5 



Table 15. Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge. 



Psychoses 




Totai 




Recovered 


Improved 


Unimproved 






M. 


p. 


T. 


M. F. 


T. 


M. 


F. 


T. 


M. 


F. T. 


1. 


Traumatic 


2 




2 






2 




2 






2. 


Senile 






















J. 


With cerebral arteriosclerosis . 






















4. 


General paralysis 


16 


1 


17 






15 


1 


16 


1 


1 


5. 


With cerebral syphilis 






















6. 


With Huntin;iton's chorea 






















7. 
























8. 


With other brain or nervous diseases 


1 


2 


3 


1 


1 








1 


1 2 


9. 


Alcoholic 


1 




1 






1 




1 






10. 


Due to drugs and other exogenous to.vins 


3 


2 


5 






3 


2 


5 






11. 


U ith pellagra 


1 




1 






1 




1 






12. 


With other somatic diseases 




5 


5 


- 2 


2 




3 


3 






13. 


Manic-depressive 


2 


7 


9 






2 


6 


8 




1 1 


14. 


Involution melancholia .... 




2 


2 








2 


2 






15. 


Dementia praecox 


6 


4 


10 






3 


3 


6 


3 


1 4 


16. 


Paranoia and paranoid conditions 




2 


2 








2 


2 






17. 






1 


1 








1 


1 






18. 


Psychoneuroses and neuroses 






















19. 


With psychopathic personality 






















20. 


With mental dehciency .... 






















21. 


Undiagnosed psychoses .... 




4 


4 








4 


4 






22. 


























Total 


32 


30 


62 


- 3 


3 


27 


24 


51 


5 


3 8 



Table 16. Causes of Death of Patients Classified with Reference to Principal 

Psychoses 











With 


















cerebral 


General 


Dementia 


Epileptic 


lAU other 


Causes ok Death 




Total 


arterio- 


paralysis 


parecox 


psychoses 


psychoses 










sclerosis 










M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


Epidemic. Endemic and Infectious 


















Diseases 


















Tuberculosis of the respiratory system 


I 




1 










1 - 1 


Diseases of the Nervous System 


















Cerebral hemorrhage, apoplexy 


1 




1 












Diseases of the Circulatory System 


















Fndocarditis and myocarditis . 


1 


2 


3 


1 - 1 








- 2 2 




1 




1 


1 - 1 










Diseases of the Respiratory System 
















- 1 1 


Bronchopneumonia .... 


2 


2 


4 




I - 1 


1 - 1 


- I 1 


Total 


6 


4 


lU 


2-2 


2-2 


1 - 1 


- 1 1 


I 3 4 



'Includes Group 22, "without psychosis". 




N ^ « « 0k o • 



50 



P.D. 137 



Table 18. Total Duration of Hospital Life of Patients Dying in Hospital Classifiet 
According to Principal Psychoses. 













Less than 




1-3 


3-4 






Psychoses 




Tota 


1 


1 


month 


month 


years 








M. 


F. 




T. 


M 


. F. 


T. 


M 


F. T. 


M. F. 


T. 


I. 
























2. 
























3. 


With cerebral arteriosclerosis 


2 


- 


2 


2 




2 








- 


4. 


General paralysis 


2 


- 


2 


- 






- 


- 2 


- - 


- 


5. 


With cerebral syphilis 






















6. 
























7. 
























8. 


With other brain or nervous diseases .... 






















9. 


Alcoholic 






















10. 


Due to drags and other exogenous toxins 






















11. 


With pellagra 






















12. 


With other sorrmtic disseises 




2 


2 


_ 


2 


2 










Ij'. 


Manic-depressive 






















14. 


Involution melancholia . 






















15. 




1 




1 








1 


- 1 






16. 


Paranoia and paranoid conditions 






















17. 






1 


1 












- 1 


1 


18. 
























19. 
























20. 


With mental deficiency 






















21. 


Undiagnosed psychoses 


1 


1 


2 




1 


1 


1 








22. 




























6 


4 


10 


2 


3 


5 


4 


- 4 


- 1 


1 



Public Document Nq^ 137^ 

A 

OIIfF (!l0mmr)inmFaUIj of iMasaarlfUfirtta 



ANNUAL REPORT 



OF THE 



TRUSTEES 



OF THE 



Boston Psychopathic Hospital 

FOR THE 

Year Ending November 30, 
1932 

Department of Mental Diseases 



Publication of this Document approved by the Commission on Administration and Financi 
650 - 4 -'33. Order 8159. 



OCCUPATIONAL PMIMTINO PLANT 
DEPARTMENT OF MENTAL DISEASES 
OARONIR STATI COLONV 
OAMONIR. MASS 



c 



BOARD OF TRUSTEES 
William Healy, M.D., Chairman, Boston. ^ lA^a 
Mrs. Esther M. Andrews, Secretary, Brooklme. / l^ii 
Carrie I. Felch, M.D., Boston. 
Chaxning Frothingham, M.D., Bo^ooL-j-p urvi m 
Allan W. Rowe, Ph.D., Boston, ^''^'t liOUo£ BOSTON 
William J. Sullivan, Boston. ^ . 

Charles F. Rowley, Boston. 

CONSULTING PHYSICIANS 
E. B. Goodall, M.D., Ophthalmologist. 
G. Philip Grabfield, M.D., Internist. 
Leon E. White, M.D., Oto-Laryngologist. 
Abraham Myerson, M.D., Xeurologist. 

E. B. Sheehan, M.D., Gynecologist. 
John Rock, M.D., Obstetrician. 

J. H. Sw^ARTz, M.D., Dermatologist. 

The staffs of adjoining hospitals 
OFFICERS OF THE HOSPITAL 
C. Macfie Campbell, M.D., Medical Director. 
Samuel Smith Cottrell, M.D., Chief Executive Officer. 
Karl M. Bowman, M.D., Chief Medical Officer. 
G. Philip Grabfield, M.D., Senior Physician. 
Edgarton M, Howard, M.D., Senior Physician. 
John P. Powers, M.D., Senior Physician. 
Oscar J. Raeder, M.D., Senior Physician. 
Harry C. Solomon, M.D., Senior Physician. 
Robert Fleming M.D., Assistant Physician. 
Hans B. Molholm, M.D., Assistant Physician. 
Mary Palmer, M.D., Assistant Physician. 
Herman Shlionsky, M.D., Assistant Physician. 
Charles B. Sullivan, M.D., Assistant Physician. 
Waldo W. Wynekoop, M.D., Assistant Physician. 
Douglas C. Alcorn, M.D., Medical Interne. 
Samuel H. Kraines, M.D., Medical Interne. 
Marjorie Meehan, M.D., Medical Interne. 
Joseph C. Rheingold, M.D., Medical Interne. 
Donald J. Simons, M.D., Medical Interne. 
Sarah V. Thompson, M.D., Medical Interne. 

, Chief of NeuTopcthological Laboratory.^ 

Myrtelle M. Canavan, M.D., Acting Chief of Nez^rovcihological 
Laboratory. 

Whjtman K. Coffin, M.D., Roe'ntgenologis'. 
Peter J. Dalton, D.M.D., Dentist. 

F. L. Wells, Ph.D., Heed Psychologist. 

Mary Fitzgerald, Principal of School of Nursing. 

Esther C. Cook, Head Social Worker. 

Alice E. Waite, Head Occupational Therapist. 

Mrs. Elveretta Blake, Librarian. 

Elizabeth Libber Shore, Treasurer. 

CONTENTS 

Report of Trustees 

Report of Medical Director .... 
Report of Out- Patient Department . 
Report of Chief Medical Officer 
Report of Biochemical Laboratory . 
Report of Psychological Laboratory 
Report of Neuropathological Laboratory 
Report of Department of Therapeutic Research 
Report of Chief Executive Officer 
Report of Social Service Department 
lieport of Superintendent of Nurses 
Report of Department of Occupational Therapy 

'By arrangement with the Department of Mental Diseases. 



P.D. 137 ^ 3 

REPORT OF THE TRUSTEES OF T^E BOSTON PSYCHOPATHIC 

HOSPITAL 

To His Excellency The Governor and The Honorable Council: 

Again this year the annual report of the Boston Psychopathic Hospital presents 
material that has wide bearings. The ever-present great public and private burden 
of mental diseases may well evoke in the minds of thoughtful citizens questions on 
many points: the possible increasing frequency of mental disease, the activity of 
investigations into causes, the cost of caring for patients, the extent and results 
of therapeutic endeavors. These and many other queries find here some answering 
data, carried as far as our present-day knowledge makes possible in this diflJicult 
and complex field. 

The two thousand patients that come and go through this hospital in a year 
have to be diagnosed for the sake of disposition by families, courts, social agencies, 
or the hospital itself. For each there must be the studies of physical conditions, 
studies which involve the techniques of many branches of medicine; for each there 
must be careful observation and evaluation of mental capacities and mental pro- 
cesses; the social, economic, and family background must be known. All this must 
be done as rapidly as is consistent with good professional standards, and the highest 
ideals of humane treatment must be observed. In addition, definite research 
programs and specialized therapies are to be maintained, calling for still more 
skilful and complicated technical procedures. 

In our regular visits and at our monthly meetings we have reported to us general 
facts about these activities, about the personnel, and the administrative side of 
the hospital. Through the smooth administration so long characteristic of this 
hospital we continue to admire the quality of the work done and to rejoice in the 
fact that so very little difficulty ensues. 

Since the days of incarceration and chaining of the insane we have gone far. 
It is rare indeed, in spite of the great difficulties of handling maniacal and suicidal 
patients, that one even hears of the slightest infractions of the rules of humane 
treatment. The spirit of kindly understanding as well as of scientific zeal pervades 
the staff at all levels. 

We are always happy to note that at this hospital the Director and his colleagues 
continually teach other physicians their craftsmanship as well as direct the programs 
of research while caring for the patients. The Chief Executive Officer has been 
particularly progressive in his conception of opportunities for bettering conditions. 
The hospital building and equipment have been greatly improved by his efforts; 
the new dining accomodations are especially a tribute to his energy. 

We have found during the year very little with which we might reasonably find 
fault. There continue to be desiderata, of course, but this is not a period in which 
to consider increased expenditures; indeed we highly commend the various economies 
that have been introduced. 

The thanks of all good citizens of the Commonwealth as well as our own are due 
to all members of the Department of Mental Diseases and the Commissioner for 
the cooperative spirit displayed, a spirit aimed at the main goal, namely, the good 
care and scientific treatment of patients from mental disease, one of the most 
deplorable of human ailments. 

Respectfully submitted, 
William Healv, Chairman Carhie I. Felch, 

Esther M. Andrews, Secretary. Charles F. Rowley 

William J. Sullivan Channinq Forthingham 

Allan W. Rowe Tnttitcea. 

MEDICAL DIRECTOR'S REPORT 
To the Board of Trustees of the Boston Psychopathic Hospital: 

In accordance with the provision of the statutes I submit for your consideration 
the report for the statistical year ending September 30, 1932 and for the fiscal year 
ending November 30, 1932. 

On the General Work of the Hospital 
In this annual report, as in previous annual reports, the general work of the 
hospital is summarized in a series of tables which give an indication of the extent 
of the work done. The tables, however, give little indication of the nature of the 



4 



P.D. 



work done; they can neither give a picture of what is involved in the treatment 
of the individual case nor of the role which is played by the hospital in relation to! 
the general welfare of the community. It may be well, therefore, at the beginning 
of the report, to restate certain general principles and to outline the general situa- 
tion as a background to the more specific data in the general body of the report. 

The hospital has to perform a variety of functions; it has to treat the sick, to 
forward scientific investigations into the causation and prevention of mental 
disorders, to give technical diagnostic assistance to such agencies as the school, 
the court and welfare organizations in their special tasks, to train a variety of' 
special workers for this field of medicine and to help through a variety of channels 
to disseminate in the community sound information in regard to mental disorders 
and handicaps. 

The primary role of the hospital is to treat the sick. While the hospital has 
only one hundred beds, it receives in the course of a year almost two thousand 
patients. The work of the hospital, therefore, has to be thought of in terms of 
this annual admission rate and not in terms of its bed capacity. Each patient 
admitted requires to have a thorough review of his actual condition with an ade- 
quate study of the situation which has precipitated the disorder, and of the family 
background and past experiences of the patient. The nature of the examination 
of the individual patient will depend very largely on the type of disorder; in some 
cases attention will be concentrated on some underlying physical ailment, m other 
cases the present stress and strain of the domestic and economic situation may 
require careful evaluation. In still other cases the mental disorder only becomes 
intelligible after a careful scrutiny of the past history of the individual with an 
analysis of the way in which he has dealt with previous tests in his life. 

The diversity of the problems presented by the patients may be illustrated by 
brief notes on five patients. 

Mental Symptoms Due to Bodily Illness: A. B., a young man, had for several 
years been suffering from a rather unusual and complicated form of anaemia. He 
had received blood transfusions, had been on a liver diet as well, had taken iron. 
Owing to some involvement of the bones of the skull, he received x-ray treatment, 
and soon after this x-ray treatment he became confused, apprehensive, heard voices 
and saw visions. He felt that people talked about his affairs, he saw palain- 
clothes men. 

In this case the mental symptoms seem to be adequately explained as the re- 
sult of special disturbances of the brain due to malnourishment and of special 
intracranial involvement. The problem in such a case is one of internal medicine 
and the methods of examination and of treatment are concentrated upon the 
patient's physical condition, and especially upon the fundamental involvement of 
the blood. There seems little reason to pay special attention to the original per- 
sonality, to the details of the life history, to the domestic and economic situation. 

A Marital Situation: B. C, a man of forty, for several years had been absurdly 
jealous of his wife and had given vent to outbursts of rage and had assaulted her. 
He had left home and on his return had given himself up to the police. 

In this case there was no evidence to indicate that the physical condition of the 
patient was below par. The patient, of foreign origin, was somewhat below par 
mentally and examination was made difficult owing to his imperfect knowledge of 
English. 

The problem in this case is very different from that of finding out the underlying 
nature of some somatic ailment. It deals with a familiar topic of human adaptation 
and the complex roots of the patient's maladjustment would require painstaking 
investigation of the development of the patient and of the role which had been 
played in his life by the sexual instinct. 

C. D., a married woman of 21 with two children, for some time had been ex- 
tremely jealous of her husband, believing (apparently without foundation) that he 
had been unfaithful, and had struck him several times. 

The situation was a very complicated one involving the personality of both 
the husband and the wife. Self-knowledge and mutual understanding were absent 
in both cases. Secondary matters such as the domestic finances were made the 
overt excuse for friction, the source of which, however, lay much deeper. 



P.D. 137 



5 



In this case a great deal of time had to be devoted both to the husband and to 
;he wife in an endeavor to promote their realization of some of the factors involved 
ind in order to suggest reasonable arrangements which would make the marital 
jituation more tolerable. The result of the expenditure of time and effort was 
gratifying and the domestic situation seemed to have been placed on a much more 
stable basis. 

Delinquency as a Symptom of Mental Disorder: D. E., a young man in the 
twenties, had on several occasions stolen autobmoiles. In view of the circumstances 
the court desired to have medical opinion upon the mental state of the accused". 
The study of the case showed a boy of a very special personality who had several 
times left home on the basis of an obscure impulse. These escapes were probably 
related to a very complicated psychological attitude towards father and mother. 
The theft of the automobile did not seem to be motivated in the ordinary way but 
to be the outward expression of repressed and obscure emotional factors. 

An Educational Problem: E. F., a lad of 11 3 2 years, appeared to his teachers to 
be feebleminded. The study of his case showed that he was neither feebleminded 
nor had any mental disorder but that there was a special disability in regard to 
reading. What the boy required was special tutoring. The case is referred to in 
more detail in the accompanying report of the Chief Medical Officer. 

A Distorted Social Outlook: F. G., a woman in the fifties, was brought to the 
hospital from the police station where she had made various statements with re- 
gard to being persecuted. She gave a long history of ill-treatment, complained that 
vomiting to which she was subject was due to her being poisoned, a gang of racke- 
teers had been after her, they had tried to poison her, her landlady had behaved 
in mysterious ways. On account of her suspicions the patient had travelled over 
the country but found it impossible to get away from her persecutors. 

In such a case, where a patient sees the world as full of hostility, the medium 
through which she is looking at the world is obviously distorted; to understand 
the factors which have distorted this medium means a prolonged discussion of her 
experiences and of the way in which she has dealt with some of the major issues 
of life. 

On the Study and Treatment of the Individual Patient 
These brief summaries may give some idea of the complexity of the situation 
which is presented by the individual patient. The physician has first of all to make 
a thorough study of the bodily condition of the patient. In the report of the Chief 
Medical Officer examples are given of the various problems that come up in this 
respect. The physical examination, however, is merely one item in dealing with 
the problem of the patient. A further step is to review the special conduct, the 
special mood, the special beliefs which have led to his being referred to the hospital. 
On the basis of such an examination the physician is able to specify the type of 
disorder from which the patient is suffering. The factors which have led to this 
disorder, however, have still to be traced. A careful review has to be made of the 
constitution of the individual in view of the hereditary endowment and of the 
personal experiences which may have made him more vulnerable; it is also neces- 
sary to reconstruct the situation in which he broke down. Such a procedure means 
a careful and painstaking review of the whole life of the patient, with due attention 
to the influence of bodily ailments and to the influence of unfavorable family, 
economic, social and general cultural factors. 

The adequate study of the bodily, personal, social aspects of the individual case 
requires a certain division of labor. The review of the bodily functions of the 
patient in the ward must be supplemented by data from the laboratory of internal 
medicine with its special equipment. The analysis of the mental functions of the 
patient in interviews with the physician is often usefully supplemented by data 
afforded by the psychologist with his methods of precision and his special experience 
in the interpretation of the results of such methods. The data supplied by the 
patient and visitors with regard to his domestic, economic and social life may have 
to be supplemented by information gathered by the field worker trained in the 
methods of psychiatric social work. 

With the large number of admissions to the hospital and with so many fields of 
inquiry to be covered in the individual case, it is necessary to have a well trained 



6 



P.D. 137 



body of specialized workers and to have the work not only well organized but carried 
out in a spirit of helpful cooperation. 

The study of the individual patient is an essential preliminary to any rationa 
program of treatment. The remarks made above as to the various fields which 
the study of the mental disorder covers already suggest the complexity of th( 
problem of treatment. There is unfortunately a wide-spread feeling that there is 
less treatment in this branch of medicine than in other branches; it is frequently 
assumed by the laity and even by many physicians that the treatment of a menta 
patient is essentially a matter of kindly care and attention to the ordinary persona! 
needs, but that there is no program of treatment based upon as definite principles' 
as those in internal medicine and surgery. This is certainly not the case. Treat- 
ment of the mental patient follows lines as definite as the treatment of any othei 
human ailment. In internal medicine there may be a greater use of drugs and o: 
other specific preparations, with precise methods for determining the reaction of th( 
various systems to those preparations. In the treatment of the mental patient j 
the administration of drugs and other preparations has a more limited appHcation 
in cases where mental disorder is accompanied by any underlying physical ailment 
the use of appropriate remedies for the latter is called for, but where there are nc 
such ailments drugs play a subsidiary role as palliative measures for inducing 
sleep, reducing excitement, eliminating apprehensiveness. 

As the study of the individual patient requires investigation not only of the bodily 
functions but of the life situation, of the past experiences, of the constitutional 
needs, and tendencies of the patient, so in the program of treatment each of these 
topics requires careful consideration. Drugs may or may not be required for the 
treatment of any physical condition present, but when it comes to dealing with the 
adaptation of the patient to his actual life situation and with the role played in his 
present disturbance by residuals from past experiences, then treatment has got to 
utilize other factors than drugs, baths, massage, light, electricity. It has to 
utilize the personal factor, the influence of the physician upon the patient, the 
specific help which can be brought to the patient by the physician who under- 
stands the underlying emotional and instinctive factors which are at work, and 
who is experienced in dealing with human nature in difficulties. In other words, 
a great role is played in treatment by psychotherapy, by the curative influences 
which are involved in the personal relationship of patient to physician and which 
are made effective in a series of interviews. In the personal relationship to an 
understanding physician the patient is able to bring up more freely and to face 
more directly underlying impulses and memories, which have been repressed but 
which have more or less haunted him. In the therapeutic interview the patient 
is able to bring these up, to see them in a clear light, to ventilate them; they thus 
lose some of their disproportionate emotional value and are grasped in the setting 
of a grown-up attitude towards life. As the interviews progress the patient sees 
more clearly the nature of his personal problems. He deals with them more openly 
and intelligently. He feels a release from distressing emotions. He acquires in- 
formation which is useful in the conduct of life. As he makes progress in these 
directions, the mental symptoms which have been the irrational expression of the 
repressed forces no longer are needed as an outlet for these forces, which now are 
allowed to come clearly into the field of consciousness of the individual in order to 
be dealt with in a rational way. 

Not all patients are open to treatment of this type. Many are too much in the 
bondage of their mental symptoms which may make such contact with the phy- 
sician impossible. The mental condition itself may withdraw the patient from 
this opportunity of help and the physician may have to wait patiently until the 
patient is ready for this form of treatment; similarly the surgeon may have to wait 
until an acute inflammation has subsided before he can proceed with constructive 
measures. 

Thus the patient who is mute and irresponsive may be lost in a world of subjective 
preoccupations which make contact with the outside world difficult. A patient 
in a state of wild excitement may not be able to hold any connected conversatior 
with the physician. A patient with an embittered attitude, which leads him to see 
hostility in everyone who approaches him, may see the physician through the 



P.D. 137 



7 



same medium and may refuse to take the first steps in social contact which might 
gradually lead to a useful therapeutic relationship. 

The treatment of many patients is, to a large extent, directed to the manage- 
ment of the patient during these difficult periods where freindly and productive 
contact with the patient is not possible. Such management in itself cannot be 
looked upon as specifically therapeutic in the sense of meeting the underlying 
factors which have given rise to the sickness and modifying them, but has to be 
looked upon more as an essential preliminary to the more radical form of treat- 
ment. Too often, unfortunately, the condition of the patient does not allow the 
treatment to be carried far beyond this stage of management, and the patient is 
already too seriously divorced from reality to be able to utilize the bond which the 
physician endeavors to establish with the patient. 

It is not enough, however, to attend to the general physical health of the patient, 
to tide him through periods of difficult social contact, to give him the opportunity 
of reviewing frankly and digesting upsetting factors; the physician must not 
allow the normal interests and activities of the patient to atrophy nor encourage 
the patient to focus interest exclusively on his or her personal diflficulties. The 
patient must be encouraged to cultivate interests in external matters and to put 
forth effort in socially constructive ways, A useful daily program has to be 
arranged for the patient with due regard to the nature of the disorder, the economic 
background of the patient, the special interests and abilities of the patient. In the 
department of Occupational Therapy an effort is made to furnish a program for 
the individual patient which will do justice to this need of the patient, and [the 
hospital is fortunate to have skilled workers in this field whose energies are en- 
thusiastically devoted to this problem. The structural limitations of the hospital, 
the absence of the facilities for outdoor activities, the limitation in the number of 
personnel make it impossible to give the patients as full a program as the physicians 
would like. The accomodation for occupational therapy is available to the women 
only in the forenoons and to the men only in the afternoons. Even a short period, 
however, of activity of this nature is a most important factor in the patient's daily 
program for maintaining healthy interests in a variety of occupations and encour- 
ing the patient to put forth effort in producing objects which are of social value, 
for the aim is to have the patients make objects which are of practical use to the 
hospital. 

The role of the nurse in the treatment of the individual case is of great importance. 
In a general hospital when the patient has received the specific nursing attention 
required by the special disorder the patient may often be left to his or her own 
devices. As a matter of fact, even in the ordinary medical and surgical wards in- 
creasing attention is being paid to the personal aspect of the patient's handicap 
so that the nurse is encouraged to learn something about the personality and the 
life situation of the patient. Such attention to the personal factors in the problems 
of illness renders the nurse increasingly efficient and gives her a broader grasp of 
the field of medicine. 

In the mental hospital this aspect of medicine is still more in evidence for there 
may be no necessity for any of the ordinary nursing procedures; the patient may 
not be bedridden, may have no wounds, require no medicines nor special form of 
physical treatment. In the past the role of the nurse in a mental hospital has often 
been thought of as purely one of management and of discipline, of dealing with 
emergencies as they came up and of carrying on a simple ward routine in the quiet 
intervals. The older terms such as ''keeper" and "attendant" give expression to 
this emphasis on custodial care. With a deeper grasp of the nature of mental dis- 
order and with some appreciation of the medical task which is laid upon the 
hospital, the nurse has to exercise her special knowledge and her native judgment in 
finding out the exact role which she plays in relation to the individual patient. 
The physician may not feel himself entitled in view of the special relationship be- 
tween him and the patient to outline to the nurse in full detail the confidences 
which the patient has given to him. Yet the nurse must get some guidance as to 
the problem of the patient and the part which she has to play in helping the patient. 
She is entitled to receive from the physician a general outline of the nature of the 
disorder, and information as to special details which may be of importance in the 



8 P.D. ISTr 

treatment of the case. With such general guidance the nurse has to make her own!'" 
special contact with the patient, not in order that she may carry on a specific 
type of psychotherapy but that she may, under the ordinary conditions of ward' 
life, give the patient a certain atmosphere and establish a human relationship which 
the patient finds of value. Not uncommonly a patient talks matters over with a 
nurse more freely than with a physician, just as in some cases a patient talks over 
with a fellow patient topics which he does not wish to talk over with the personnel j' 
of the hospital. s] 

The systematic development of psychiatric nursing is an important task for the, » 
medical and the nursing profession. The problem is not only to train special nurses r 
for work in this field but to train all nurses to have a sufficient knowledge of the t 
principles of work in this field, so that they may be more efficient in their general t 
nursing and not lose sight of the patient in attention to the patient's disease. [ 

In the Boston Psychopathic Hospital there is a constant stream of affiliated t 
nurses who come from their own hospitals for a period of three months in order toi i 
get some insight into this special field. This rapid change of personnel is a draw- 
back in so far as it means a smaller number of nurses of experience available for 1 
the regular work of the hospital; on the other hand, the fresh arrival of nurses i 
from different hospitals, keenly interested in a somewhat new problem, is a stimu- 
lating influence. In the course of one year the Boston Psychopathic Hospital gives < 
training tD fifty -six affiliated nurses. 1 

On the Special Departments of the Hospital and the Coordination of 

Their Work 

In the body of the report will be found brief summaries of the work which is i 
done in the various special departments of the hospital. The remarks above on 
the general work of the hospital indicate the various aspects involved in the study, 
treatment and care of the patient. 

The report of the Chief Executive Officer gives an idea of the general problems • 
of the administration of the hospital, with that attention to the basal services and 
supplies which is fundamental for the smooth working of the special services. 

The report of the Chief Medical Officer lays special emphasis upon the great 
variety of bodily ailments which enter into the more complex problems of the mor- 
bid behaviour and morbid beliefs of the patients. For the detailed study of the 
physical processes modern medicine requires a rather elaborate supplement 
of the bedside examination by examinations which are more appropriately done 
in the adjoining laboratory but which are to be looked upon as an essential part 
of clinical medicine. The examination of the blood, the urine and the cerebrospinal 
fluid may be made in an adjoining room instead of by the bedside, but such an 
examination is not to be looked upon as of a character different from observation 
of the breathing and the heart sounds. Increase of knowledge andthe application 
of ingenuity continually lead to further elaboration of old methods and discovery 
of new methods which require new apparatus. 

The condensed summary of the work of the psychological laboratory may not 
give full expression to the work which is done by this department in helping the ' 
clinical staff to deal with some of its most complicated problems. In a great many 
of the patients referred by the courts the question of interpretation and disposal 
may be largely influenced by an estimate of the original endowment of the individual 
in regard to "intelligence." In regard to the estimation of the problems and the 
recommendations in the case of the majority of the children referred to the hospital 
an estimate of their general intelligence is also of the greatest importance. In 
addition to the problems of general intelligence there are special functions which 
require to be investigated with greater accuracy than is common in clinical work, 
and the psychological staff have paid much attention to the analysis of memory 
and to a study of the personality traits of groups of patients. Special reference , 
may be made to the specific work on one test of special value (the Rorschach Test) 
and to another piece of work on the mental level of infants and very young children. 

In a great number of patients the symptoms which have led to admission and 
the program of treatment can only be intelligently discussed on the broad back- 
ground of the patient's life situation with its domestic, economic and broader social 
aspects. The woman who comes in under the delusion that people are trying to 



P.D. 137 



9 



make her a bad woman, to take away her religion and make her give up her 
inhibitions may, in these symptoms, show the difficulties of her actual life at home, 
the repression of natural instincts, the inadequacy of substitutive satisfactions, 
the impossibility of getting along any longer under the somewhat drab and dreary 
conditions of the actual situation. 

The problem of the patient very often, therefore, is a social problem, and to do 
justice to this social problem the personnel of the Social Service Department are 
specially trained. Through their investigation it is possible to reconstruct more 
adequately the factors which have led to the breakdown, and through them the 
recommendations of the physician with regard to reconstructive work can be 
translated into concrete terms, so that the patient may go home to a situation which 
has been made more tolerable, and may have at her disposal social resources which 
previously she did not know about. The social service worker has her own special 
training in methods and data and develops a knowledge of the local community 
and its resources which are of the greatest value. 

The patients come from many racial groups, with different codes, religions, diets, 
habits, and in the treatment of the individual case one has to pay due value to the 
importance of these broader factors. 

The social service is a very important liaison between thfe hospital and various 
organizations in the community both official and unofficial, whose field overlaps 
the field of work of the hospital. The courts with their delinquents, the schools 
with their problem children, the welfare agencies withtheir domestic situations, 
the child-placing agencies, the employment agencies, the churches with their social 
organizations — with each of these the social service-department keeps in close 
touch. Through the social service department many of these agencies bring their 
problems to the hospital and get the recommendations of the hospital trans- 
mitted to them. 

It is a constant study in this department to see how far the problems which are 
referred to the hospital are formulated in a way that is useful and the inquiries 
accompanied by all the relevant data which the referring agency has, and how far 
the special recommendations which are made by the physicians are in a form which 
the worker in a welfare agency or in a school can assimilate and utilize. A re- 
cently made survey of the mental hygiene of Boston showed how important it is 
that the liaison between the hospital and the various agencies should be made a 
living connection and not become a somewhat dry interchange of formal and 
technical communications. 

On the Promotion* of Research 
One of the primary purposes of the hospital is to promote investigation into the 
fundamental causes of mental disorders, a role as important in the long run to the 
welfare of the community as the actual treatment of those who have fallen by the 
wayside. To many it seems poor economy to devote so much time and money to 
problems connected with the treatment of those who have fallen sick while al- 
most a negligible sum is devoted to the more fundamental problem of ascertaining 
the causes of mental disorders and of dealing in a constructive way with these 
causes. 

The staff of the Boston Psychopathic Hospital have little time for consecutive 
and uninterrupted research and have not at their disposal the generous facilities 
which are often available in research institutions. On the other hand, in the regular 
work of the staff an endeavor is made to foster the spirit of curiosity and of thought- 
ful approach to problems for investigation. The nature of mental disorders shows 
how wide is the field open for investigation. The physical processes which are re- 
sponsible for many types of mental disorder are often known only in outline. 
There is need of greater knowledge of the relation of mental disorders to the general 
chemistry of the body, to disorders of the gastro-intestinal and other systems, to 
infective processes. The physician finds much to investigate in regard to the emo- 
tional life, the reactions of different types to disturbing situations, the role played 
by the imagination, the origin of hallucinations, the value of special tests, and 
other topics. There is also need for research into factors of great social importance, 
which have an important bearing on the stability of the home and the social value 



10 



P.D. 137 



of the individual; much work has to be done in studying the requirements of chil- 
dren with special defects such as in reading or in speech, or with faulty social 
behaviour. The material of the Boston Psychopathic Hospital throws a valu- 
able light upon many problems of the school and of the home, problems of the 
management of the sex life, of the relation of child to parents, of' 
the emancipation of the adolescent, of adult adjustment to various social and i 
economic demands. In the reports from the various departments of the hospital, i 
the special topics of investigation which have been in the foreground during the c 
past year are emphasized. The comparative neglect of neuropathological investi-, t 
gation in the program of the hospital's activities is still a matter of regret, but the i 
hospital has no pathologist of its own. 

On the Work of the Out-Patient Department 

Modern medicine has come to lay increasing stress upon the importance of the 
prevention of disease and upon the early diagnosis and treatment of disease. Ini 
the field of psychiatry this tendency has led to an increasing concentration upon 
the problems of childhood and upon the early stages of individual maladjustment. 
It is hoped that by the intelligent study and guidance of childhood not only may 
some individuals be saved from shipwreck in adult life, but those who are not 
specially vulnerable will gain in fullness and efficiency of life. 

The hospital through its Out-Patient Department endeavors to give expression 
to this principle of modern psychiatry. It offers an opportunity for parents, 
teachers and welfare workers to get advice with regard to the guidance of the in- 
dividual child. It offers to adolescents and adults an opportunity of getting advice 
with regard to their personal problems without that interruption to their daily life 
which would be involved in admission to the hospital. 

In the report from the Out-Patient Department and the Social Service Depart- 
ment one sees the great variety of problems which are presented to the workers 
in the Out-Patient Department for consideration and advice. Between the infant' 
about to be adopted who is brought for examination, and the discouraged elderly 
city employee who is still on his job, but who finds stimulus and encouragement 
from contact with the physician in the Out-Patient Department, are patients of 
both sexes and all ages who bring to the Out-Patient Department their personal 
problems. In many cases the patient is sent for a diagnostic review of limited 
extent so that in a comparatively brief period the physician can give the referring 
agency the result of the special examination. In other cases it is not a question 
merely of a consultant's opinion but the patient comes for treatment and this, as 
indicated in the early paragraphs of the report, involves a painstaking review of 
the personality of the patient, of the various phases of his individual development' 
and of the special qualities of the life situation. 

Treatment of this type necessarily involves a long serious of interviews each of 
considerable duration. It is, therefore, one of the problems of the Out-Patient 
Department to see how far such treatment can be made available to those in- 
dividuals who require it, while leaving enough time for the problems of other i 
patients where such a detailed review is not necessary. 

The appointment system has been in use now for the second year and is being 
carefully watched to make sure that its advantage of saving the time of patients 
is not offset by discouraging a certain number of patients whose willingness to 
consult a physician is somewhat wayward and impulsive and whose very symptoms 
may make it difficult for them to arrange to keep an appointment. 

In the work with children there has been not only the continuation of the regular 
work of surveying backward children in the special school district allotted to the 
hospital but also special attention continues to be given to the earliest period of 
development by Miss Jones. Work has been done on the special defects of school 
children and arrangements made for special tutoring. 

In dealing with the problems of the behaviour of children, while a good personal^ 
contact is made with the individual child by the physician, the guidance to a large' 
extent consists in dealing with the situation, especially with the personality of the! 
parents or the guardians of the individual child. 



P.D. 137 



11 



On the Trainixg of Personnel 

In addition to acting as one of the health units of the community and as a centre 
of investigation into the problems of mental disorders, the hospital acts as a centre 
of training for various types of workers. There is a constant stream of young 
physicians who, through their internship at the Boston Psychopathic Hospital, 
lay the basis of their later work in this special field or prepare themselves by a year's 
work in psychiatry for dealing more efficiently in their general practice or in their 
other specialized activities with the personal problems of their patients. In addi- 
tion to the resident staff, a number of graduate workers come to the hospital for 
various periods for special training. The special facilities of the hospital are also 
utilized by the students of the various medical schools. 

In each of the special departments workers are trained for specialized activities 
along definite lines. In the psychological department the psychologist gets an 
opportunity of preparing himself for a special field of psychology which is closely 
related to the medical field of psychiatry and, on the basis of his training in the 
hospital, is better equipped for taking up responsibilities connected with court 
work or school work or work in mental hospitals. 

In the department of occupational therapy, workers from the Boston School of 
Occupational Therapy have an opportunity of getting experience in field work, 
while at the same time they contribute much to the efficiency and the general 
atmosphere of the department. 

In the Social Service Department as well as in the nursing service the individual 
worker is not only contributing service to the hospital but is also going through a 
systematic form of training. 

In addition to the above systematic teaching, the hospital in various ways 
through its contact with the personnel of other health and welfare organizations 
in the community acts as an educational centre. 

Concluding Remarks 

In the report special emphasis has been laid upon the service which the hospital 
renders to the community and the various specialized activities through which 
it tries to fulfil its task. In each of its departments the workers have their own 
specialized interests as well as their interest in the common task to which they 
make their special contribution. In each department topics of special interest 
engross the worker, opportunities for further investigation appear, facilities for 
carrying out these investigations are desired. 

For most investigations on medical topics one requires not merely space but 
apparatus and personnel. The expanding interests in the various departments 
and the constructive program of the individual workers are seriously cramped 
by limitations of structure and of finance. To do justice to the needs of the workers 
in the various departments it is very desirable that arrangements should be made 
whereby much more space is available for laboratory purposes. Financial re- 
strictions, too, prevent the prosecution of many pieces of work which are of 
promise. 

The hospital is fortunate in having a group of workers who accept loyally the 
conditions as they are, throw themselves into the work with industry and intelli- 
gence, and whose main thought is to do the best with the facilities which are already 
available. In the hospital with its busy service, its somewhat cramped quarters, 
its varied personnel, the harmony of the group is one of the most satisfactory 
features, and this is a suitable opportunity to express may deep appreciation of the 
good fellowship of the personnel of the hospital. 

I take this opportunity also of thanking the Board of Trustees for the continua- 
tion of that solicitous interest in the welfare and efficiency of the hospital which 
they have shown in previous years. 

It is also a pleasure to express appreciation of the support which has been con- 
sistently received from Dr. Kline, Commissioner of Mental Diseases who has 
throughout given sympathetic consideration to all problems which have been 
brought before him. 

HespectfuUy submitted, 

C. Macfie Campbell, 

Medical Director. 



P.D. 137; 



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P.D. 137 



13 




14 



P.D. 137 



REPORT OF THE OUT-PATIENT DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith submit the annual report of the Out-Patient Department for the year 
ending November 30, 1932. 

The staff of the clinic during the past year was as follows: 
Dr. C. Macfie Campbell, Director of the Hospital. 
Dr. Oscar J. Raeder, Chief of Out-Patient Department. 
Dr. Mary Palmer, Assistant Physician. 
Dr. Chalres B. Sullivan, Assistant Physician. 
Miss Annie C. Porter, Clinic Manager. 

Special Workers: Dr. Ella Prescott Cahill; Dr. Henrj^ B. Elkind: Dr. Doror! ■ 
L, Green: Dr. Henry Norman; Dr. Mary B. Spahr; Dr. Bertrand H. Pulskamp. 
Dr. Hortensia A. F. Robinson. 

Students: Jacques S. Gottlieb, September 29 to October 24, 1931; Henry Rey- 
nolds, November 24 to December 24, 1931 ; Emmett Settle, February 4 to February 
29, 1932; John B. Dynes, May 2 to May 25, 1932. 

During the year 1931-1932 there were 938 new patients, including 6S cases of 
neurosyphilis. Excepting the latter there were 870 new patients, of whom 4no 
were male, and 470 female. Four hundred and forty-one patients or 50.6^ we: 
adults, 164 or 19-7 were adolescents, and 265 or 30.4*^7 were children. The reasor.s 
for which these people consulted the clinic were numerous. For convenience they 
have been grouped under the following headings: (a) beha\ior; lb) domestic: 
(C) educational; (d) neuropathic; (e> personality; (/) routine examinations; 
vocational; (h) a miscellaneous group. 

The sources of material are also various. Social agencies referred the large - 
number, 344 or over 39^7- 1-^2 or 15.1^7 were referred by other hospitals; 1-^ 
or 13.1^ were referred by private phj'^sicians : 107 or 12.2^7 by relatives or frienc 
37 or 4.2-7 by the schools: and 37 or 4.2-7 by the courts. The remainder or 12.2 
came from various sources see table , including 43 or 5*;^ which were referred ■ 
the Boston Psychopathic Hospital after discharge. 

The diagnoses among the adults were as follows: Psycho neuroses head the list 
with 168 cases, 19.3-7 the total new cases. Last year only 9.6^7 were so diag- 
nosed. The relative increase of males over females was 6*^7» from 42-7 year 
to 48^7 this year. The economic stress due to business depression has been a 
frequent factor in these cases. It is logical, too, that the greatest increase has been 
among the male patients who have been more directly affected by unemployment. 
Thus, idleness of mind and increased economic worries loom up large as causes of 
neurotic symptoms. 

Among the other larger groups the schizophrenic psychoses are noteworthy. 
Forty or 4.5^7 cases were definitely or tentatively so diagnosed. Of these 18 were 
males and 22 females. Manic-depressive psychoses and other affective conditions 
numbered 30 or 3.4 ^7 » 10 of which were males, and t^ice as many, v*iz, 20, wer° 
females. Con\'ulsive states, including epilepsy, were diagnosed 17 times or 1.9 
and psychopathic personality 15 times, or 1.7 '^7- 

Among the children and adolescents, feeblemindedness again is the largest group. 
Not including those children diagnosed as retarded or borderline, there were 56 
cases, 28 boys and 28 girls. The number of children diagnosed as retarded or 
borderline together numbered 82 cases, 47 boys and 35 girls. This group would 
precede by sheer numbers the former group, but we have elected to place the feeble- 
minded first inasmuch as the probable degree of error in diagnostic judgment is 
much less in the ' feebleminded" group. 

Neurotic children were so diagnosed 38 times, or 4.3^^, 21 of whom were male 
and 17 female. There were 17 normal children, mostly cases for adoption who 
were referred primarily for intelligence rating. 

It is interesting to note that there were 11 children, 7 males and 4 females, of 
superior intelligence. Superior children are potential cases of misbehaviour, 
especially when they are placed too low in the school grades for their mental ages 
and capabilities, and there is not sufficient demand made on their time and on 
their superior capacities. 

Under the law ^Chapter 215, Acts of 1931; which requires a physical and mental 
examination of all children who are about to be committed to public institutions, 



P.D. 137 



9 



15 



there were 95 cases, 86 males and 9 females, examined. This law is largely a check 
to secure for feebleminded or psychotic children the proper care and training as 
provided in the divers state institutions for children, juvenile delinquents, and 
others. 

The examination of the retarded children of the Brookline schools was again 
conducted under the auspices of the Out-Patient Department in charge of Dr. 
Mary Palmer as psychiatrist, aided by the following staff: 

Mrs. Gertrude Pierce, teacher. 

Mrs. Ada Joyce, Visiting teacher. 

Mrs. Greely S. Curtis, social worker. 

Miss Viola Jones, psychologist. 

Mrs. P. S. deQ. Cabot, student assistant psychologist. 
The following is the report of this year's survey. 

Names of Schools and Number of. Students Referred 
Baldwin ... Heath .11 Pierce . .29 

Cabot .... Lawrence Runkle ... 9 

Devotion ... 5 Lincoln .19 Sewall ... 4 

Driscoll .38 Parsons ... 1 Winthrop . .10 

Total 126 

Boys 88; Girls 38. 

Examined for first time: boys, 72; girls, 36; total, 108. 
Examined for second time: boys, 16; girls, 2; total, 18. 
Classification of pupils examined for the first time on basis of Intelligence Quiotent 



1. Q. 69 or 

less 

(Feebleminded) 


I. Q. 70-79 
(Borderline) 


I. Q. 80-89 
(Dull) 


I. Q. 90-109 
(Average) 


I. Q. 110 
and over 
(Superior) 


T. M. F. 


T. M. F. 


T. M. F. 


T. M. F. 


T. M. F. 


1 1 


16 8 8 


32 19 13 


50 36 14 


9 8 1 


Total: 108; boys, 72; girls, 36. 

Classification of Pupils re-examined in 19S1-19S2 


I. Q. 69 
or less 
(Feebleminded) 


I. Q. 70-79 
(Borderline) 


L Q. 80-89 
(Dull) 


I. Q. 90-109 
(Average) 


L Q. 110 
and over 
(Superior) 


T. M. F. 


T. M. F. 


T. M. F. 


T. M. F. 


T. M. F. 


1 1 


5 5 


8 7 1 


4 3 1 






Total: 18; Boys, 16; girls, 2. 

Recommendation for Special class 
First examination: total, 5; boys 3, girls 2. 

Recommendation for special class — re-examination 
Total, 1; boys 1, girls 0. 

Recommendation for Institution care — re-examination 
Total, 1; boys 1, girls 0. 

Retardation 

SI students were 1 year retarded: ' 

2 were of borderline intelligence. 

10 were of dull normal intelligence. 

19 were of average intelligence. 

S8 students were 2 years retarded: 

•Chapter 231. Section 46. of the General Laws, was amended in 1931 to include children retarded leM 
than two Years and those with behavior problems. 



16 



P.D. 137, 



2 were feebleminded. 

10 were of borderline intelligence. 
15 were of dull normal intelligence. 

11 were of average intelligence. 
6 students u-ere 3 years retarded: 
3 were of borderline intelligence. 

3 were of dull normal intelligence. 

3 students -were ^ years retarded: 

2 were of borderline intelligence. 

1 was of dull normal intelligence. 
Reading disabilities 18 students — boys 18, girls 0. 
The following table is an analysis of these eighteen students: 
Grades Students Grades Students 

First 2 Fifth 2 

Second 6 Sixth 1 

Third 2 Seventh 

Fourth 4 Eighth 1 



Reading Disabilities 



Number 








School 


Reading 


Cases 


C. A. 


M. A. 


/. Q. 


Grade 


Grade 


1 


8 


8- 4 


104 


1 





2 


5- 4 


6- 4 


119 


IB 




3 


7- 7 


8- 


105 


2 





4 


8- 6 


8- 3 


97 


2 





5 


9- 7 


8- 9 


91 


2 





6 


11- 3 


7-10 


70 


2 





7 


8- 1 


8- 6 


105 


2A 


1.9 


8 


9- 4 


7- 8 


82 


2A 





9 


9- 6 


9- 3 


97 


3 


2.8 


10 


9- 9 


9- 3 


95 


3B 





11 


10- 2 


9- 7 


93 


4 


2.6 


12 


10- 3 


10- 3 


99 


4 


3.6 


13 


11- 2 


8- 


72 


4A 





14 


11-10 


10- 1 


85 


4B 


3 


15 


11-11 


10- 1 


85 


5 


3.4 


16 


12- 7 


10- 4 


81 


5 


3.1 


17 


12-11 


12-10 


90 


6 


4.6 


18 


13-10 


13-11 


101 


8B 


5.7 



The following statistical tables are self-explanatory and deal further with the 
work of the clinic. 



Statistics of the Out-Patient Department 
October 1, 1931 to September 30, 1932 



Total new cases . . . . 








. 938 


Out-Patient Department, 870; 


Syphilis Division, 68. 








New Patients: 














Male 


Female 


Total 


Adults 




186 


255 


441 


Adolescents 




59 


105 


164 


Children 




155 


110 


265 






400 


470 


870 


Plus: 










Syphilis patients . . . . 




30 


38 


68 






430 


508 


938 




Nationality 












Males 


Females 


Total 


African 




12 


12 


24 


Armenian 




3 


3 


6 


Danish 




1 





1 



P.D. 137 



17 



Dutch 




i 


Q 


English 




CA 

o4 




Finnish 




Q 
O 


q 


French 


r 



1 "7 


zz 


German 


Q 

6 


n 
I 


1 n 
lU 


Greek 


A 

4 


A 

4 


Q 
O 


Hebrew 


KQ 
OO 


40 


QQ 
Mo 


Irish 


nc\ 
/U 


CA 

b4 


1 0/< 

lo4 


Italian. ......... 


o4 


A K 
4D 




Lithuanian ........ 





A 
1 


q 


rolisn .......... 


1 
i 


1 
1 




Portuguese 


4 


n 
i 


11 


Scandinavian ........ 


1 1 
1 i 


Q 
O 


1 A 
14 


ocotcn .......... 


Q 

u 






Slavonic .......... 


c 
D 


A 




Spanish 


1 


U 


1 

1 


Syrian 


7 


1 


8 


Mixed race 


82 


79 


161 


Race unascertained ....... 


48 


93 


141 




400 


470 


870 


Heferred Hy 










Male 


r emale 


1 oral 


1 • TT • 1 

Boston Psychopathic Hospital .... 




1 K 


4o 


Other hospitals ........ 


oy 


'TQ 
1 O 


1 QO 

loZ 


Private physicians ....... 


i 


I 


114 


Social agencies ........ 


lUo 


Zoo 


Q/l A 

o44 


Court .......... 


O 1 


/? 
D 


o ^ 
6 i 


Department of Immigration 


U 


i 
1 


1 


ocnool ......... 




Q 


O / 


Boston Traveler 


1 





1 


Relatives and friends ...... 


/ 




1 n" 
lU < 


Own initiative 


25 


18 


43 


Department of Mental Diseases ... 


6 


o 
O 


6 


Police .......... 


1 




1 


Church 





2 


2 


Employer 


1 





1 


Walter hi. rernald otate ocnool .... 


1 
i 


u 


1 




400 


470 


870 



Problems 

An attempt has been made to classify the problems on account of which the 
clinic was consulted into the following eight headings. This is a more or less 
arbitrary grouping, it being often difficult to decide whether cases of running away, 
sex delinquency, lying, etc. for example, should be included under "behaviour 
problems", under "personality problems", or under the "neuropathic" group. 

a Behavior: Misconduct, running away, sex delinquency, disobedience, lying, 
stealing, exhibitionism. 

6. Domestic: Abnormal home situation, economic, bigamy, establishment of 
home, re-establishing home. 

c. Educational: Intelligence rating, retardation, reading difficulty, violating 
school law, speech difficulty, truancy. 

d. Neuropathic: Nervousness, hysteria, fear and worry, agitation, dizziness, 
tremors, enuresis, temper tantrums, depression, alcoholism, dazed condition, in- 
ability to think, somatic complaints, shakiness, continual tiredness, excitability, 
fainting spells, hallucinations, gagging in throat, threats of suicide, constipation, 
walking difficulty, seizures, wry neck, irritability, ideas of reference, screaming 
spells, restlessne.ss, delusions, emotional difficulty, twitching, weakness, cr< » : 
sensation, insomnia, crying spells, convulsions, refusal to talk, sex conflict, gran . 



18 



P.D. 137 



ideas, stuttering, sleepy spells, pain in head, photophobia, "spirit in body", ideas 
of persecution, lapses of memory, psychosis, excessive self-criticism. 

e. Personality: Seclusiveness, peculiar personality, lack of interest, distractibility, 
lack of adjustment, lack of ambition, mismanagement. 

/. Routine examination: Psychometric testing, adoption, psychiatric examination 

g. Vocational: Ability to work, vocational advice, re-establishment in business, 
ability to care for children. 

h. Miscellaneous: After-care, institutionalization, placement. 

Diagnosis 









Male 


Female 


Total 


Alcoholism 








5 




5 1 


Senile psychosis . ...... 










4 


4 , 


Psychosis with cerebral arteriosclerosis . 










2 


2 


General paresis (questionable) 








4 




4 


Alcoholic psychosis ...... 








1 




1 


Manic-depressive insanity .... 








10 


20 


30 


Involutional melancholia. .... 










2 


2 


Schizophrenia 








18 


22 


40 


Paranoia ........ 








2 


5 


7 


Epileptic psychosis ...... 








2 




2 


Psychoneurosis ....... 








81 


87 


168 


Psychosis with psychopathic personality 










1 


1 


Psychosis with feeblemindedness 








5 


4 


9 


Undiagnosed psychosis ..... 








1 


1 


2 


Without psychosis ...... 








4 


6 


10 ' 


Without psychosis (for intelligence rating) 














Superior intelligence ...... 








7 


10 


17 


Adults ........ 




6 


6 








Adolecents ....... 


4 


4 


8 








Children ....... 


3 




3 








Average intelligence ...... 








37 


58 


95 


Adults ........ 


2 


11 


13 








Adolescents 


7 


2'7 


34 








Children ........ 


28 


20 


48 








Retarded and borderline intelligence 








51 


47 


98 


Adults ........ 


4 


12 


16 








Adolescents ....... 


14 


16 


30 








Children 


33 


19 


52 








Feeblemindedness ...... 








30 


39 


69 


Adults ........ 


2 


11 


13 








Adolescents ....... 


3 


8 


11 








Children 

V> lllivll CJXi. ....... 


25 


20 


45 








^ (^C'dVAllXg V./ Ik^IV^Xli ...... 








6 


3 


9 


Stammering and other speech defects 








2 


1 


3 


Diagnosis deferred 








52 


72 


124 


Neurotic child 








21 


17 


38 


Normal child 








8 


9 


17 


Conduct disorder 








18 


20 


38 


Chorea 








1 




1 


Poliomyelitis 








1 




1 


Tinnitus 








1 




1 


Post-encephalitis 










2 


2 


Organic disease of central nervous system . 








2 


3 


5 


Central nervous system lues .... 








1 




1 


Parkinson's diseases 








1 


1 


2 


Endocrine 








2 




2 


Psychopathic personality with mental deficiency 






10 


10 


20 


Personality defect 








3 


12 


15 


Epilepsy 








6 


11 


17 


Constitutional psychopathic inferiority. 








3 




3 



P.D. 137 



19 



Arteriosclerosis 1 - 1 

Chronic arthritis 2 - 2 

Rheumatic heart disease and chorea - 1 1 

Gonorrhoea 1 - 1 



400 470 870 

Disposition 

Male Female Total 

Boston Psychopathic Hospital 50 58 108 

Out-Patient Department 187 163 350 

State hospital advised 4 13 17 

General hospital advised 2 2 4 

Agency report 122 219 341 

Court report 27 9 36 

Relatives 4 2 6 

Waverley advised - 1 1 

Wrentham advised 3 3 6 

Habit clinic 1 - 1 



400 470 870 

Visits 

Total visits 2,850 

New patients 2,036 

Out patient department 1,908 

Syphilis clinic 68 

Old patients 814 

Clinic days 300 

Average number of visits per day 9 

Number of patients and number of visits per year 



Old Patients 


Visits 


Total 


New Patients 


Visits 


Total 


105 


1 


105 


519 


1 


519 


56 


2 


112 


147 


2 


294 


29 


3 


87 


67 


3 


201 


13 


4 


52 


35 


4 


140 


14 


5 


70 


31 


5 


155 


4 


6 


24 


19 


6 


114 


4 


7 


28 


10 


7 


70 


2 


8 


16 


13 


8 


104 


1 


9 


9 


5 


9 


45 


2 


10 


20 


5 


10 


50 


3 


11 


33 


6 


11 


66 


3 


12 


36 


4 


12 


48 


1 


13 


13 


3 


13 


39 


1 


15 


15 


2 


14 


28 


1 


17 


17 


1 


15 


15 


1 


23 


23 


1 


20 


20 


1 


25 


25 


1 


28 


28 


1 


29 


29 


1 


32 


32 


1 


30 


30 








1 


70 


70 








244 




814 


870 




1,968 



As in previous years, clinical staff meetings for the discussion of particular cases 
studied in the clinic were held on Mondays and Wednesdays throughout the year. 
These are presided over by the director and are an important factor in stimulating 
the work of the staff as well as the students of medicine, psychology, sociology, and 
nursing. 

Executive staff meetings have again been held on Friday mornings. The cases 
studied during the week are discussed medically, as well as problems of policy and 
administration. Representatives of social and other agencies, school teachers, 



20 



P.D. 137 



and probation officers are invited to these conferences. The interchange of ideas 
and opinions as to treatment, advice, and follow-up work at these conferences 
make for a more understanding relationship between the clinic and referring 
agencies. 

I wish to record here the wholesome spirit of cooperation of all the staff members 
of the various departments of the hospital, which has contributed largely to the 
successful handling of the many difficult and patience-taxing problems coming 
before a neuropsychiatric clinic. 

Respectfully submitted, 

Oscar J. Reader, 

Chief of Out-Patient Depart. 

REPORT OF THE CHIEF MEDICAL OFFICER 

To the Medical Director of the Boston Psychopathic Hospital: 
I hereby submit the report of the medical service. 

The general routine of the hospital has continued much the same during the past 
year. It seems worthwhile in this report to call attention again to the great variety 
of cases admitted to this hospital, and to the many demands made upon the diag- 
nostic and treatment facilities of this institution. Many persons do not realize 
that a hospital of this type is called upon to treat all types of medical and surgical 
conditions which may be present as a cause of the mental disorder, or may develop 
as complicating factors. 

For this reason a series of illustrative cases are quoted showing some of the 
important medical problems which arise in connection with these cases. 

K.L., a married man of 37, was brought into the hospital with the statement 
that he had struck his wife twice, and had beaten his children severely. He was 
sent in by his family physician. Further study showed that the patient had a fall 
about eleven -months ago, that he was unconscious for three days, and had a 
fracture of the lumbar vertebra. Since then he suffered from pain in the back and 
legs. He became more irritable, particularly when he was suffering from his back. 
It was also noted that the patient's features had been becoming more coarse for 
the past four years, and that his nose and hands had grown bigger. This case, 
although sent to a psychopathic hospital, presented problems of neurology and 
endocrinology. The patient was developing an acromegaly which was linked up 
with the personality change. The effect of the fall and the invalidism following it 
required evaluation. In the study of this case, it was necessary to have careful 
x-ray examinations, a study of the spinal fluid, and a study of the fields of vision. 
For this latter examination a perimeter is necessary. The one which the hospital 
has at present is very old. A much more accurate study of the fields of vision could 
be made with a newer type of perimeter. A well-equipped room for doing eye 
examinations would be desirable. 

E.W., a widow of 37 years, was brought into the hospital with the statement 
that she was excitable and threatening to jump out of windows. Further examin- 
ation showed that the patient had a fairly typical depression which had come on 
gradually following the sudden death of her husband about three years before. She 
was somewhat undernourished, and there was a question of her having had a 
syphilitic infection. Serological examination ruled out the latter. Her treatment 
in hospital consisted of psychotherapy, hydrotherapy and occupational therapy. 
She responded to all three of these methods and was so improved at the end of six 
weeks that she was able to go home and take her place in the community. She 
has continued to come back three mornings a week for hydrotherapy, and two 
mornings a week for occupational therapy. She finds that she has derived great 
benefit from such treatment and wishes to continue it. 

G.B., a married man of 54, was sent into the hospital by his physician with the 
statement that he was a case of hysteria, that he complained of some difficulty in 
walking, that the neurological examination was entirely negative, and that there 
were many psychological causes for his trouble. When first admitted the patient 
complained of weakness, stated that he could not walk, but when reassured was 
able to do so. In a short time he developed many neurological symptoms. A 
diagnosis of brain tumor was made. A neurosurgical consultant agreed with this 
diagnosis. Surgical interference was not felt advisable. Autopsy confirmed the 



P.D. 137 



21 



diagnosis of brain tumor. This case illustrates some of the difficulties of diagnosis 
between organic and functional conditions, and the necessity of careful neurological 
studies on all patients. 

C.L., a married woman of 38, was sent into the hospital by the court. She had 
been arrested, charged with drunkenness. In this case an elaborate study was made 
by the Social Service Department in which the patient's previous court record, the 
examination by the court psychiatrist, and interviews with three informants, three 
social agencies, and two hospitals were obtained. There was a question of fainting 
attacks of an obscure nature. The patient had a great many physical complaints". 
The question of epilepsy was considered. There was considerable question as to 
whether there was some heart disease which was responsible for the fainting 
attacks. X-rays of the heart were made and the patient was sent to a general 
hospital for an electrocardiogram. These examinations proved to be essentially 
negative, and the case was finally considered to be that of an unstable feeble- 
minded woman who used alcohol to excess and quarreled with her neighbors. This 
case illustrates the various ways in which the problem is studied from the social 
service angle, from the general medical standpoint and from the psychological 
standpoint, the special tests by a psychologist confirming the diagnosis of feeble- 
mindedness. An electrocardiograph would be of considerable service in diagnosing 
some of the obscure cases which come to this hospital. At present, the only possible 
thing to do is to transport the patient to another hospital for such studies. In 
many cases this is not practical. It is hoped that this hospital will be able to secure 
an electrocardiograph in the near future. 

W.B,, a married man of 39, was admitted to this hospital having been transferred 
from a general hospital. Mentally, he was recovering from an acute alcoholic 
hallucinosis. Physically, there was a fracture of the left leg which was in a cast. 
While in this hospital the patient required not only the ordinary treatment of an 
alcoholic psychosis, but special surgical treatment for the fracture, his cast requiring 
to be changed. 

R.R., a married man of 50, was admitted to the hospital with the statement that 
he had not worked for several years, that he felt run down, and that he was doing 
a number of queer, odd things. He also had seizures in which he was unconscious. 
This case was one of organic brain disease, and brain tumor, arteriosclerosis, 
syphilis and encephalitis were considered. Encephalograms were made, but no 
conclusive diagnosis was reached and the patient was transferred for further study 
and treatment to another hospital. This case illustrates again the necessity of 
careful neurological examinations, and the importance of x-ray examination in the 
determination of the diagnosis. Fortunately, this hospital is equipped with an 
excellent x-ray outfit and makes frequent use of encephalography. Ideally this 
patient should have had a ventriculogram done in a neurosurgical ward, where 
immediate operation could have been carried out if a diagnosis of brain tumor was 
made. It cannot be expected that this hospital will be equipped to do operative 
work for brain tumor; such patients indicate the need of a psychiatric ward in 
general hospitals. This patient was too disturbed and uncooperative to be looked 
after in the ordinary ward of a general hospital. 

N.D,, a married woman of 59, was admitted to the hospital with the statement 
that she had been confused for the past two weeks, had had dizzy spells, and that 
she had become quite excited and noisy and imagined that people were trying to 
harm her. On admission it was found that her heart was markedly enlarged and 
decompensated. 

Under treatment, by rest m bed and digitalis, the patient improved markedly, 
both physically and mentally. This case illustrates a type of mental disorder 
symptomatic of an underlying physical condition, where the essential problem is 
the treatment of the physical condition. However, because of the mental con- 
dition the patient cannot be cared for in a general hospital unless there is a psy- 
chiatric ward. 

F.W., a single man of 41, was brought into the hospital with the statement that 
he had been drinking, that he had possibly fallen down while intoxicated, and that 
he was complaining of intense pain in the head with dizziness, and weakness of the 
legs. On admission he was in a semi-stuporous condition, showed numerous neuro- 



22 



P.D. 137 



logical signs which indicated an organic brain disease. The patient died in less 
than 48 hours of a subdural hemorrhage. 

A.H,, a widow of 41, was sent to this hospital from a general hospital with the 
statement that she had convulsions and delirium following a fall, and that she was 
so noisy and violent she could not be cared for in a general hospital. Examination 
of this patient gave no definite neurological findings. X ray of the skull was 
negative as well as the examination of the spina] fluid. Under good nursing care 
the patient cleared up in ten days so that she was able to returr. home. She still 
complained somewhat of headache, and it was considered that she had probably 
had a fall with a slight internal hemorrhage which had produced the symptoms. 

C.F., a boy of 113^ years of age, was sent into the hospital from an orphan's 
home with the statement that he would not cooperate in school work and was 
making poor progress, that he showed no interest in his work and no sense of 
responsibility. On admission, the physical examination showed poor nutrition 
and a question of pulmonary tuberculosis. After x-ray studies and further ex- 
aminations, it was felt that tuberculosis was not present. A series of special psycho- 
logical tests showed that the patient was of normal intelligence, but that he was a 
case of strephosymbolia, that the right eye and left hand were aominant. The fact 
that the boy was a non-reader accounted for a great deal of his trouble. A plan 
was worked out for the boy to receive special instruction which, it was felt, would 
insure his overcoming the trouble to a large extent. There was, however, very little 
cooperation from the institution which sent him to this hospital; the head of the 
institution would not keep his appointment with the social worker of this hospital, 
he tended to treat the matter as a joke. As a result a plan was worked out for the 
patient to be transferred to another institution for children where he would receive 
special training. This case illustrates some of the complications which arise in 
trying to treat patients. 

R.R., a boy of 18, was admitted to the hospital with the statement that he had 
been suffering for a year and a half with what had been called a chronic meningitis. 
He had had a fall on his head and had apparently been unconscious. Details 
concerning this were not available. When admitted to this hospital he showed 
many neurological signs which were suggestive of meningitis. X-ray examina- 
tion and blood cultures were carried out. The spinal fluid showed 128 cells, 54 of 



which were small lymphocytes, total protein 396, there was a low spinal fluid sugar ' 
and changes in the colloidal gold. Cultures of the spinal fluid were negative. As ] 
there might be a walled-off process in one of the ventricles, arrangements were j 
made for a neurosurgeon to trephine the skull and tap the ventricle. Antimeningitis \ 
serum was administered, but the patient grew steadily worse and died after 14 days 
in the hospital. The post mortem examination showed a basal meningitis with a ^ 
hydrocephalus of some months' standing. | 
R.L., a divorced man of 54, was sent in by the court accused of larceny. When ! 
first admitted, he gave an account of his past life which included graduating from 
college and having inherited $750,000 from his father. A careful check-up on his 
record by the Social Service Department showed th^t this was not true. A long r 
criminal record of some 23 arrests in 12 different states was found. After many 
interviews, and careful study it was felt that the patient did not have a psychosis 
but was a psychopathic personality, able to stand trial. 

V.S., a married woman of 31, was admitted to this hospital after having been 
in two general hospitals. At the first hospital she was regarded as merely nervous; 
at the second hospital it was felt that she was either a case of dementia praecox or ; 
encephalitis, probably the former. Because of the fact that she kept jumping out ; 
of bed and could not be controlled, the general hospital did not feel able to look : 
after her. On admission, the physical examination was essentially normal. She ' 
was mute, resistive, refused to eat, would wet and soil herself. She gradually de- ; 
veloped a quite excited state. The blood sugar went up to 236 mgs., sugar and casts ! 
appeared in the urine. The patient developed a double lobar pneumonia, and \ 
certain neurological findings appeared which made the diagnosis of encephalitis '\ 
seem probable. The patient died 12 days after admission. Autopsy was refused. | 

O.B., a married woman of 50, was admitted to this hospital with a diagnosis of 
involution melancholia. The condition had been coming on for several months. 



J 



P.D. 137 



23 



She had been committed to another hospital for mental diseases where she had 
improved to some extent. The family then removed her and took her to a Christian 
Science Home. There her condition became so much worse that she was finally 
brought to this hospital. On admission she was very restless, uncooperative and 
showed the picture of an organic delirium. She had a temperature of 103.4. Various 
medical and surgical consultants saw the patient, and a tentative diagnosis of 
pneumonia was made. An oxygen tent was used which made the patient more 
comfortable. She died 21 days after admission. Autopsy showed pulmonary ab- 
scesses and bronchopneumonia. This case also illustrates the need of a portable 
x-ray machine. The question of a central pneumonia or lung abscess was considered 
early in her sickness, but she was felt to be too sick to remove to the x-ray room for 
x-ray studies. A portable machine would have enabled one to take the x-ray at 
the bedside. 

P.G., a married woman of 30, was sent into the hospital from the court with the 
charge of carrying a loaded gun and threatening to kill her father. This case 
necessitated an elaborate study by the Social Service and attempts to evaluate the 
statements of various members of the family who took sides in the difficulty between 
the patient and her father. It was concluded after intensive study that the patient 
was suffering from a definite psychosis of a paranoid type. The court finally allowed 
the patient to be placed on parole on condition that she should leave the state, as 
it was felt that her paranoid ideas applied only to her father. 

The hospital has during the past year received an increasing number of cases 
from the courts; 237 cases were committed to this hospital by the courts under 
Section 100; of this number referred by the courts, 72 or approximately one third 
were committed as insane to state hospitals. 

In checking over the different courts, it is of interest that the court which employs 
two psychiatrists sent in 56 cases, 27 of whom were committed. This higher per- 
centage of committable cases is unquestionably due to the fact that there was more 
careful selection in the cases sent here, and indicates that courts which do not em- 
ploy psychiatrists probably send a certain percentage of cases for observation to 
this hospital when there is no need of such observation. This demonstrates the 
value of a court psychiatrist in examining persons, and picking out the cases that 
require special study in hospital. 

The number of volunteer workers and fellows at the hospital has increased, so 
that at the present time the facilities of the hospital are fully utilized. Three 
doctors from the staffs of other Massachusetts State Hospitals have worked here 
for brief periods as a part of their training. There are at present eight fellows in 
psychiatry working in the hospital. This has allowed a great deal more research 
to be carried out. 

Since the Veterans Bureau has discontinued the use of our Out-Patient Depart- 
ment for its afternoon clinic, this space has been available. Because of the over- 
crowding of the Out-Patient clinic mornings, it seemed worthwhile to attempt to 
inaugurate an afternoon out-P&tient clinic for children. This has been started 
during the past few weeks. Cases are referred by appointment only, and it is hoped 
to carry out some intensive work with children. This does not interfere with the 
regular morning out-patient clinic which still continues to see all variety of cases, 
including a number of children. At present the clinic is open three afternoons a 
week. 

The greatest need is for more psychiatric social workers, and with the limited 
number available at the hospital the work of the afternoon clinic will be definitely 
curtailed and handicapped unless there is some way of providing for this need. 

The report of the dentist follows: 



Patients examined . 1,709 

Patients treated . . 1,004 

Extractions . . 1,016 

Fillings . .509 

Prophylaxis 222 

Other treatments 267 



In our studies of dental x-rays, 36',; showed definite infection; 21% were doubt- 
ful; 29[ 'c were entirely negative. The remaining 14' ; were negative for infection, 



24 



P.D. 137 



but showed impacted teeth. X-ray examination in one case showed a large cyst 
of the mandible. 

In the impacted teeth the order of frequency was: lower third molars, upper 
third molars, upper cuspids, and bicuspids. 

Examination of smears for Vincent's angina were positive in two cases. 
The report of the x-ray laboratory shows increased use of this department. An 
endeavor has been made to make more intensive studies on some of our patients, 
to utilize more fully flouroscopy, to have our x-ray consultant meet with the doctors 
and discuss the interpretation of the films. 

X-ray Report for Year December 1, 1931-December 1, 1932, 





M. 


F. 


T. 




M. 


F. 


T. 


December . 


. 35 


23 


58 


June 


. 40 


16 


56 


January 


. 26 


19 


45 


July . 


. 31 


18 


49 


February . 


. 14 


11 


25 


August 


. 23 


14 


37 


March 


. 31 


25 


56 


September . 


. 17 


15 


32 


April 


. 27 


26 


53 


October 


. 38 


16 


54 


May 


. 24 


23 


47 


November . 


. 26 


17 


43 



Male, 332; female 223, total patients 555. 

Respectfully submitted, 

Karl M. Bowman, 

Chief Medical Officer. 



REPORT OF THE BIOCHEMICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

The first full year of operation of the Biochemical Laboratory under its present 
regime ended on November 30, 1922. It seems appropriate, therefore to compare 
the quantity and character of the work done in the year 1932 with that of the 
year 1922. Certain changes in the routine have been made, which accounts for 
the increase in the number of examinations of stained blood films; in 1922 each 
patient on admission had a hemoglobin determination and a blood smear, whereas 
now the white blood count is substituted for the smear. The accompanying table 
shows the work done by the clinical laboratory force (the student internes) except 
the spinal fluids and basal metabolisms. When one considers that the annual admis- 
sion rate is essentially constant, the increase indicates a more extensive laboratory 
study of our patients. 

Table I 

Comparison of clinical laboratory work done in comparable periods in 1922 and 1932 



(one week: J^3 admissions). 
Examination 1932 1922 

Urines 107 72 

White blood counts 87 8 

Red blood counts 10 

Hemglobin 53 45 

Differential counts 2 

Gastric analysis 1 1 

Table II 
November 1, 1931 to November 1, 1932 

Total specimens cerebrospinal fluid 1,895 

Outside fluids 538 

Treatment cases 287 

Gold sol readings 1,895 

Positive gold sols 630 

Total protein determinations 1,266 

Sugar determiniations 1,004 

Special analyses (NaCl and Ca) 17 

Total specimens blood 476 

Non-protein nitrogen 280 

Sugar 396 



P.D. 137 



25 



Special 214 

Bromides 77 

Urea 18 

Uric acid 34 

Creatinine 27 

Calcium 6 

Cholesterol 12 

Phosphorus 3 

Serum proteins (total, albumin and globulin) 3 



Total analyses (exclusive of gold sols) 3,178 



It was with a great deal of surprise that we discovered how many spinal fluids 
were being done (Cf. Table II). The medical student internes who spend three 
years in residence at this hospital, all have some part in all the spinal fluid exam- 
inations. This, therefore, represents an experience of 5,000 to 6,000 spinal fluids 
for such a man. It may be emphasized that no comparable training is available 
elsewhere. Inasmuch as most of our students ultimately become internes in general 
hospitals, the other work is of a less unique character than the spinal fluid exam- 
inations and basal metabolism determinations. In general, each man has one 
year of work at the latter type of determination which in 1932 totalled 264 determin- 
ations. This represents a larger experience, as so many of our patients require nu- 
merous attempts before satisfactory readings can be obtained. It is excellent 
training for our internes to learn to secure the co-operation of our very difficult 
patients. 

As has been said before in these reports, it is our feeling that this type of service 
is an ideal one for the men who must help themselves through medical school. 
That this is recognized by the student body is shown by the fact that we have 
never wanted for applicants of the highest type in excess of our needs. In times 
of economic depression, the demand for positions such as these becomes very large. 
As a consequence, we are in a position to help deserving students whose funds have 
been curtailed by prevailing economic conditions. The routine work is always well 
done. We have always encouraged the internes to pursue some research activity 
in conjunction with whatever was going on in the laboratory, and some have done 
excellent work in this way. In the past two or three years, however, we have had 
a considerably smaller number with a flair for investigation. However, one of the 
men has proceeded on an independent problem, consisting in an intensive study of 
the low basal metabolic rates found in psychiatric patients, which he is carrying 
through to a very successful conclusion. 

The remainder of Table II indicates the work done by the junior chemist. In 
addition to the clerical work, it will be seen that she performs something over 3,000 
analyses a year which averages about 8 a day. Were these all the same, it would 
represent a small amount of work, but they are not, and cannot be grouped so 
that the same type analysis falls on the same day. Some of them are quite laborious, 
especially when done in small numbers at long intervals. The work of keeping up 
standard solutions occupies no small part of her time. She does the chemical work 
on the spinal fluids while the internes do the globulin, cell count and gold sol de- 
terminations. I have not included a tabular view of the chemist's work in 1922 as 
this was but a fraction of that done at the present time in variety and a little over 
a third in quantity. 

In looking backward over the past decade, one notes that the investigations 
undertaken have largely centered about the interests of the undersigned and, as 
a result, have a distinct pharmacologic and metabolic taint. Many of them have 
no direct relation to psychiatry except insofar as metabolic reactions are grist 
to the mill of the modern psychiatrist. In the past year, in accordance with the 
plans mentioned in my last report, a new policy has gradually come into being, 
which relates the laboratory more closely to the work of the psychiatrists of the 
hospital. This refers to the use of the laboratory by the clinical staff in solving 
their special problems. There has been a special effort made this year to develop 
this phase of our work. Dr. Bowman, of course, continues his use of the laboratory 
in his investigation of the treatment of patients with endocrine substances. 



26 



P.D. 137 



Before coming to us this year, Dr. Michaels made some studies on the relation- 
ship between calcium and potassium in psychiatric patients. He is now engaged 
in extending these studies to include simultaneous studies of this and other relation- 
ships in the blood and spinal flviid. 

Dr. Fleming has begun a study of alcoholic patients from a new angle and will 
utilize some of the newer methods for the determination of alcohol in body fluids. 

Dr. D'Elseaux has continued his studies of the reaction of patients to increasing 
quantities of carbon dioxide in the inspired air. By his energy, this study has been 
extended until a very well-equipped laboratory for the study of blood gasses is 
proceeding with various researches under his direction. This will be reported in 
greater detail by the Department of Therapeutic Research. In a budgetary sense, 
the unit of Dr. D'Elseaux lies between that Department and this laboratory, though 
the active direction remains in the Department of Therapeutic Research. 

It is our feeling that this is only a small beginning, but a hopeful one, in the 
direction in which we wish to develop the laboratory in the next decade. It is 
necessary that our work be tied very closely to clinical psychiatry. The most 
effective method to accomplish this is to stimulate the younger psychiatrists to 
use the laboratory and to think of their problems in the terms of internal medicine. 

In relation to the staff, Mrs. Bishop has been succeeded as junior chemist by Miss 
Mildred G. Gray, who came to us from Dr. Higgins' Laboratory at the Massachu- 
setts General Hospital. Miss Gray has easily fulfilled all the requirements of her 
position and has maintained the very high standard set by her predecessors. The 
student-interne system continues to work satisfactorily as far as the routine clinical 
work of the hospital is concerned. According to the plans of the Chief Executive 
Officer, our internes will have in the future remodelled and better quarters than 
has hitherto been the case. 

Our physical equipment remains the same except for the addition of two new 
microscopes. I find that it is exactly ten years since the last microscopes were 
purchased. There are no immediate laboratory needs. 

As Consultant in Medicine, I believe that the hospital should have an electro- 
cardiograph. We see a surprising number of cardiac patients. Since our medical 
histories are apt to be inadequate, due to the mental condition of the patients, we 
should have every aid in diagnosis and guide to treatment that can be supplied. 
The interest of the staff in the physical condition of their patients has shown a 
tremendous increase. Dr. Bowman, Chief of Staff, and the two Chiefs of Service, 
Drs. Howard and Fleming, are to be highly commended for their activity in this 
direction. It is always a pleasure to bear witness to the enthusiastic and stimulating 
co-operation of the Director and also the Executive side of the hospital. The 
Director steadily keeps in mind the relationship between physiological mechanisms 
and mental status and, in his stimulating fashion, continues to pose questions and 
problems for the laboratory to attack. 

Our publications since the last list, have been as follows: 

"The Action of Cinchophen"; Journal of Pharm. & Experimental Therap., 
vol. XLII, No. 4. August, 1931. by G. P. Grabfield, and J, H. Pratt. 

"A Note on the Relation Between Blood Cholesterol and Basal Metabolic 
Rate." N. E. Journal of Medicine, vol. 205, No. 24, December 10, 1931. By 
G. P. Grabfield and A. G. Campbell. 

The staff for the past year has been as follows: 

Junior Chemist: Madeline B. Bishop, September 1931-June 1932. Mildred G. 
Gray, June, 1932. 

Student Internes: J. R. Frazee, M.D., September 1931-December 1932. K. 
B. Olson, September 1931-October 1932. H. C. Jackson, September 1931. T. R. 
Ingham, September, 1931. D. B. Hall, September 1932. M. J. O'Brien, December 
1932. 

Respectfully submitted, 

G. Philip Grabfield, 

Chief Biochemist. 



P.D. 137 



27 



REPORT OF THE PSYCHOLOGY LABORATORY 

To the Medical Director of the Boston Psychopathic Hospital: 

In a report some years ago, a classification of the laboratory's activities was made 
under the heads of clinical, psychometric, teaching and research; and this classi- 
fication has in some sort served as a frame of reference for subsequent reports. In 
the earlier years of the present laboratory organization it was endeavored to keep a 
certain balance between these different fields of functioning, but any one is capable 
of absorbing the laboratory's entire work capacity, so that some must at least 
temporarily be held in check that others may develop. An emphasis upon certain 
research projects in the field of learning about four years ago, led to the accumu- 
lation by the writer of a considerable body of experimental records, but demands 
of more immediate nature have led the evaluation of this material to proceed but 
slowly. The demands of teaching have become more insistent, and a functioning 
of the research spirit in this setting has led to experimentation with various teach- 
ing devices, leading to resultsof interest both for teaching method and the psychology 
of symbolism which is involved. The courses given every three months to small 
groups of affiliate nurses have been of great service in this respect, and are being 
thereby steadily improved. A short text (about 25,000 words) has been specially 
prepared for these classes, and will be available in manuscript form to the present 
group. The writer also organized a series of over 500 slides, for this as well as 
more advanced levels of teaching, and additional projection apparatus has been 
installed. If the now critical need of more space can be met, there can be made a 
physical set-up very satisfactory for the laboratory's ordinary teaching functions. 

The revised form of the Alpha test as constructed in the laboratory has now been 
published (in one of the forms only) by the Psychological Corporation, New York. 
Agencies of the Commonwealth desiring to use the test can ordinarily obtain a 
few copies from this laboratory, but for any quantity should communicate with 
the Gardner State Colony. To agencies of the Commonwealth, the "Short Alpha" 
mentioned below, is similarly available. The laboratory's adaptation of the Army 
Beta technique continues to function usefully, particularly between the "mental 
age" levels 10-14. Agencies desiring to use it as a convenient check or substitute 
for performance tests, should communicate with the laboratory regarding special 
material and instructions thereon. The new and authoritative pre-school scale 
developed by Goodenough and Anderson has also been introduced, as well as an 
improved recording system for the more distinctive portions of the Kuhlmann- 
Binet system. 

The laboratory has been fortunate in a leading part in the development of the 
Rorschach test, undertaken with the coming to the laboratory of (now) Dr. S. J. 
Beck in 1929. This year he obtained his doctorate at Columbia with a thesis in 
this field, and remains during the currient year as research fellow in the Department 
of Psychiatry, Harvard Medical School, devoting full time to this work. It has 
conspicuously attracted the attention of the medical staff, and been helpful in the 
integration of psychological and psychiatric interests. 

Mr. Nathan Goldman, an advanced graduate student at Clark University, joined 
the laboratory staff on Dr. Beck's resignation (the only staff change of the year), 
bringing to it a background of experimental psychology for which the physical 
resources of the laboratory afford but limited scope. In addition to the routine of 
his office, he has arranged a research project in the establishment and extinction of 
conditioned reflexes as related to factors like intelligence level, and psychotic states. 
He has also been effective in devising always much needed further economies in 
laboratory space. 

Mr. C. K. Atwell has carried to completion his work on an abridgment of the 
Alpha test ("Short Alpha") revision, obtainable as mentioned above, [but not in 
course of publication. Various points of a research nature, growing out of the work 
of standardizing these new procedures, will be prepared for publication as time 
permits. Mr. Atwell also undertakes certain extra-mural psychometric work 
required for prisoners, with which he has had considerable experience. 

'The work of Miss Viola Jones with young children, in the Out-Patient Depart- 
ment has attracted increased attention, and arrangements are being made to pro- 
vide her with some volunteer assistance in caring for it. Among these activities 



28 P.D. 137 

is included a psychometric study of thyroid therapy among cretin children, under- 
taken in collaboration with Dr. Gerald Hoeflfel of the Children's Hospital. A small 
motion picture camera, purchased several years ago in connection with studies of 
emotional expressions, has been of considerable use to her. A group of children 
presenting distinctive personality problems (particularly abnormal play life) is 
being followed intensively with reference to possible prepsychotic features. If the 
child guidance service of the Hospital develops beyond its present proportions, it 
will considerably reinforce the need for an additional psychologist, as suggested in 
the report of last year. 

Appreciative mention is due to the work during the past year of two volunteer 
assistants, Mrs. Virginia Walker, who did much of the work on the series of slides 
now available to the laboratory, and to Miss Prudence MacKissock, who was en- 
gaged chiefly in bibliographic work. 

The considerable secretarial worK essential to the above activities, for some years 
under the conduct of Miss Katharine R. Kelly, continues at its previous high level. 

The integration of laboratory's work, other than routine, with the interests of the 
psychiatric staff, is a problem ever present because of shifting personnel, and the 
limited time in which insight into its workings, largely foreign to medical education, 
must be acquired. The services of Dr. Beck in this connection have already been 
mentioned. Besides occasional presentations of its work at formal meetings of the 
medical staff, there have been organized weekly teas and conferences in the labora- 
tory quarters, to which members of the medical and social service staffs are invited. 
The group functions somewhat as a seminar, but there is no aim at continuity in 
topics from meeting to meeting. 

The writer has continued his work with a committee of the Social Science Re- 
search Council, which has organized a seminar for a group of about fifteen fellows 
from foreign countries, now being held at Yale University under the direction of 
Proferssor Sapir. A brief series of lectures was given during the spring at the Rhode 
Island State Hospital. During the summer, the two courses given in 1929 were 
given as revised, at Teachers College, Columbia University, the value of this 
experience to the various teaching functions of the laboratory being difficult to 
overstate. There have continued such routine cooperative activities as with 
Child Development Abstracts, Psychological Abstracts, and the Psychological 
Index. 

Publications have been as follows: 
Beck, S. J. "The Rorschach Test as Applied to a Feeble-Minded Group." Colum- 
bia University, Archives of Psychology, No. 136, 1932. 
Wells, F. L. "Army Alpha — Revised." The Personnel Journal, vol. X, No. 6, 

April, 1932, 411-417. 
Wells, F. L. " Evaluation of Personality and Character Tests." American Journal 
of Orthopsychiatry, vol. II, No. 4, October, 1932. 

Respectfully submitted, 

F. L. Wells, 

Head Psychologist. 

REPORT OF THE NEUROPATHOLOGICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

Since the beginning of the Hospital, June 1912, there have been 283 autopsies, 
an average of about 14 a year: For the most part these have been done by the 
pathologist and student interne for the Department of Mental Diseases who are 
quartered here. This year there were 31 deaths; of these 8 autopsies were done 
by the medical examiner and 12 done by the officers of the Department, a per- 
centage of 64. Those done by the medical examiner showed death to have come 
to these patients from infections following suicidal attempts in three, frank suicide 
in one, and pneumonia in three; in one as yet the cause is unknown. Four were 
women and four men, and the majority (6) were under 40 years of age. 

Of the 12 done by the writer or substitute, 10 were males, and two were females. 
Their ages varied from 19 to 58 and the majority were due to frank infections (8), 
of which two were tuberculous. In two cases direct inoculation of brain material 
into media was attempted by the Department of Bacteriology at the Harvard 
Medical School, to substantiate an opinion that they suffered from Encephalitis 



P.D. 137 



29 



Lethargica, but no positive results were obtained. Two had pulmonary infractions, 
one an organic heart lesion, and one was one of the unproven encephalitis cases. 
The major trunk organs and the spinal cord are sectioned and described, as well 
as representative cortex sections. One epileptic who died of lobar pnuemonia and 
cerebral hemorrhage had palpable firmness in the cornua ammonis. 

Demonstrations of brain anatomy have continued every three months to the 
nurses. 

Mr. A. E. Nielsen, the interne in bacteriology, reports: blood cultures, 17; 
miscellaneous cultures, 40; Widal's reaction, 4; auto vaccine, 1; darkfield examina- 
tions, 2; miscellaneous smears, 33; and he also assists at autopsies and in care 
and examination of tissues. 

Respectfully submitted, 

Myrtelle M. Can a van. 
Pathologist, Department of Mental Diseases. 

REPORT OF THE DEPARTMENT OF THERAPEUTIC RESEARCH 

To the Medical Director of the Boston Psychopathic Hospital: 

Probably the most important thing to report this year is that there has been 
developed a relatively stable organization capable of handling not only its own 
investigative problems but also prepared to offer assistance to the various members 
of the hospital staff who may have special problems with a bio-chemical angle. A 
reasonably adequate biochemical laboratory has grown up. This was started a 
couple of years ago in connection with studies on the effect of the inhalation of 
carbon dioxide in stuporous conditions. Dr. Frank C. d'Elseaux, a Commonwealth 
Fund Fellow in Psychiatry, undertook the study of this subject, as has been noted 
in previous reports. Receiving training and assistance from Doctors Henderson 
and Dill of the Fatigue Laboratory of Harvard University, Dr. d'Elseaux developed 
a laboratory for the study of various bio-chemical problems at the Boston Psycho- 
pathic Hospital. Fortunately, arrangements have been made so that on the con- 
clusion of his Commonwealth Fund Fellowship, November 1, 1932, Dr. d'Elseaux 
becomes a Fellow in Psychiatry at the Harvard Medical School, and continues his 
work at the Hospital. 

In addition to Dr. d'Elseaux's work on the carbon dioxide inhalation in the 
stupors, which was reported at a meeting of the American Neurological Society 
at Atlantic City in the Spring of 1932, a number of studies have been carried on. 
Among these may be mentioned a consideration of the acid-base balance in the 
hospital patients which indicates that some of these patients are more acidotic 
than normal individuals. Dr. d'Elseaux considers it fair to assume that the change 
from the normal acid-base balance is due to a diminished response of the respiratory 
centre either to the increased acidity, or to the increased carbon dioxide content 
of the blood. The group on which these studies have been made is being enlarged 
and an attempt is being made to understand this phenomenon. 

Studies of the oxygen-combining power show that there are certain patients who 
lack the normal degree of adaptation in the oxygen carrying mechanism. Further 
studies in this field are to be undertaken. 

Studies have been made on lactic acid metabolism, the results of which seem to 
refute some of the currently accepted theories as to the effect of anoxemia, acidity 
of the blood, and exercise on the metabolism of lactic acid. 

As indicated, Dr. d'Elseaux's work is to be continued not only along the lines 
already mentioned, but reaching out into other problems. Dr. d'Elseaux has in 
his laboratory two well-trained and experienced bio-chemical technicians, Miss 
Peterman and Miss Marsh. 

Dr. S. H. Epstein continues his acitivities and has been very largely responsible 
for the conduct of the neurosyphilis clinic. In addition to this work, he has under- 
taken several other studies. He has investigated the effects of some of the non- 
volatile anesthetics such as pento-barbital, sodium amytal, and avertin, in the 
control of excited patients and especially of their value in the facilitation of lumbar 
punctures. He has also developed a technique for the utilization of non-volatile 
anesthetics in the performance of encephalography; at the same time developing, 
in association with Dr. Hanflig, an ortheopedist, a table for the performance of 



30 



P.D. 137 



encephalography under anesthesia; and with the X-ray Department a technique 
for taking roentgenograms with the patient in a sitting position. One of the 
difficulties with encephaolography has been the marked discomfort suffered by 
the patient. In addition, the work is made difficult by vomiting on the part of 
the patient, which interferes both with the injection of air, and the taking of the 
roentgenograms. Under the anesthesia as used by Dr. Epstein, these difficulties 
are almost entirely obviated. Reports of this work have been published in medical 
journals. 

Dr. I. Kopp has been associated with the Department during the year, and has 
assisted Dr. Epstein in his work. Dr. Kopp has devoted himself in addition to the 
routine problems of the clinic, to various studies related to hyperpyrexia induced 
by diathermy and now has ready for publication a paper on metabolic rates at 
different temperature levels in hyperpyrexia induced by diathermy. He has also 
studied the effects of some of the anti-pyretic and sedative drugs in relation to dia- 
thermy fever. 

In the report of the previous years, attention was given to work undertaken at 
the hospital on epilepsy, especially in regard to dehydration and acidosis. It was 
stated that this was looked upon as a long-term investigation. Unfortunately, 
because of the lack of funds, the ward in which these studies were being made had 
to be closed, and the studies discontinued. It is our hope that at a later date a 
continuation of these studies may be undertaken. It may be stated at this time, 
however, that the results of careful chemical studies on epileptic patients having 
ketogenic diets indicate that even the ' most intense acidotic" diets fail to alter 
the acidity of the patient more than a trifle, and that simple dehydration gives 
rise to as much increase in acidity as the acidotic diets. 

The clinic devoted to the treatment of neurosyphilis has continued to increase 
in size. A study of cases of general paresis treated with malaria between February, 
1925, and February, 1931, has been completed in the current year. The series 
consist of 174 patients. Briefly stated, the study shows that 65 of the 174 patients, 
or 37.3% are improved and at work while 22 more or 12.6% are improved sufficiently 
to be living in the community but are not self-supporting. In other words, practi- 
cally fifty per cent of these 174 paretic patients have been able to return to the 
community. Another 22, or 12.6%, while improved, have had to remain hospi- 
talized for various reasons, chiefly economic, but nearly all of them are relatively 
adequate workers under institutional conditions. It should be mentioned that 
these results have been obtained not by malaria alone, but by malaria therapy 
assisted by drugs such as tryparsamide, arsphenamin, and bismuth. Studies of the 
effect of tryparsamide treatment without malaria are now to be made as well as 
studies of the effect of treatment in other types of neurosyphilitic patients. 

Since March, 1931, investigations have been made on the effectiveness of fever 
produced by diathermy in the treatment of neurosyphilis. This period has been 
too brief to allow any final conclusions. However, a brief summary may be given 
of the work from March, 1931 through May, 1932. During this period thirty cases 
of neurosyphilis were treated by diathermy, consisting of 19 cases of general paresis, 
3 of tabo-paresis, 5 cases of tabes with visceral crises, 2 cases of tabes without crises, 
and one case of cerebral syphilis. Clinicai improvement was noted in eleven patients, 
or 36.6% of this group. Fourteen patients, or 46.6% continued to be confined in a 
mental hospital. Two patients died in the course of a few months. Of the five 
tabetic cases with visceral crises, two may be considered symptomatically improved, 
the other three patients continuing to have recurrent attacks of gastric crises. It 
was noted in one case that the abdominal pain was invariably relieved during dia- 
thermy treatment and for a few hours thereafter. 

A word of appreciation is due to Mr. Thomas McHugh, 11. N., for his conscientious 
work as technician in charge of the diathermy treatment. 

Under Dr. Epstein's supervision, a new filing system for cases of neurosyphilis 
has been installed. This consists of cross index cards by diagnosis and name, 
according to types of therapy, and results, social status, etc. This system covers 
approximately a ten-year period of 1922 onward, and allows for easy reference to 
all of the experiences in the handling of cases of neurosyphilis. The installation 
of this rather elaborate index was made possible by volunteer service of two workers, 



P.D. 137 



31 



namely. Miss Rena Richter and Miss Oona Ryan, whose assistance is greatly 
appreciated and hereby acknowledged. 

Dr. Merrill Moore, a Commonwealth Fund Fellow in Psychiatry, has devoted 
part of his time and energy to studies in neurosyphilis and with Dr. Houston 
Merritt, of the Boston City Hospital Neurological Staff, is preparing a treatise on 
neurosyphilis. 

The following table will give a statistical summary of the work done in the 



treatment of neurosyphilis. 

Visits may be 452 persons 5,647 

By 315 persons to clinic for treatment 5,397 

By 137 relatives for examinations 250 

Total treatments given 315 cases 5,040 

Acetarsone .... 15 Malaria 39 

Arsphenamine .... 822 Neoarsphenamine . 126 

Bismuth 693 Tryparsamide . 2,874 

Diathermy .... 326 Typhoid Vaccine . .117 

Intraspinal 20 Ventriculographies. 1 

Encephalographies ... 7 Diagnostic Lumbar Punctures 1,136 

Per cent of new families followed who were examined 77 . 1 

Per cent of new relatives followed who were examined 74 .5 

Per cent of families examined showing evidence of syphilis . 23 . 6 

Per cent of relatives examined showing evidence of syphilis .15.2 



The social service work in the neurosyphilitic cases continues as in previous years 
under the direction of Mrs. Maida H. Solomon and Miss Ruth Epstein. 

The financing of the work of this Department comes from rather diverse sources. 
In addition to the support given from the hospital budget, funds have been made 
available by the Division of Mental Hygiene of the Department of Mental Diseases, 
by the Harvard Medical School, through the Department of Psychiatry and the 
DeLamar Mobile Research Fund; by the Commonwealth Fund of New York 
through their psychiatric fellowships; and by the Joseph M. Herman Medical 
Research Fund. 

Appended hereto is a list of communications published, or prepared for publica- 
tion during the year: 
Publications: 

Solomon, Harry C. "The Treatment of Neurosyphilis." The Urologic and 
Cutaneous Review, April, 1932, Vol. 36, No. 4, pp. 223-228. 

Solomon, H. C. and Epstein, S. H. "Encephalography under Narcosis Pro- 
duced by Non-Volatile Anesthetics. Jour. Amer. Med. Assoc., 98:1794, May 
21, 1932. 

Epstein, S. H. and Dameshek, W. "Involvement of the Central Nervous 
System in a Case of Glandular Fever. New England Jour. Med. 205, p. 1238, 
Dec. 24, 1931. 

Epstein, S. H. and Marvin, F. W. "Observations on Pentobarbital Sodium 

in Lumbar Punctures, Convulsive and Manic States. N. E. Jour. Med. 

207:258, August 11, 1932. 
Mederith, Lois and Solomon, Maida H. "The Trend Study." News Letter, 

American. Assoc. of Psychiatric Social Workers, Vol. 1, No. 4, Jan. 1932. 
Epstein, S. H. "Chemotherapy of Neurosyphilis. Rhode Island Med. Jour. 

Vol. XV, No. 11, 175, November, 1932. 
Prepared for Publication: 

Solomon H. C. and Kopp, I. "Metabolic Rates at Different Temperature 

Levels in Hyperpyrexia Induced by Diathermy. 
Solomon, H. C. and Epstein, S. H. "Differential Effects of Arsphenamin and 

Tryparsamide," Amer. Jour, of Syphilis. 
Epstein, S. H. and Lott, George. Lumbar Punctures in Psychotic Patients. 

Jour. Ner. and Ment. Diseases. 



32 



P.D. 137 



Epstein, S. H. and Hanfliq, S. S. "A New Apparatus for Encephalography." 
Amer. Jour. Roentgenology. 

Solomon, H. C, Merritt, H. H. and Moore, Merrill. "The Iron Reaction 
in Paretic Neurosyphilis." Am. Jour. Syph. July, 1933. 

Solomon, H. C. and Moore, Merrill. '"Hereditary Syphilis, by L. Babonneix" 
a book review to appear at a future date in the Arch, of Neur. and Psycho. 

Merritt, H. H. and Moore, Merrill. "Cases of Tumor of the Brain Asso- 
ciated with marked Pleocytosis in the Cerebrospinal Fluid". To appear in 
the Jour, of Neur. and Psychopathology. 

Solomon, H. C. and Epstein, S. H. " Treatment of Neurosyphilis. I. Malaria 
in the Treatment of General Paresis." 

Respectfully submitted, 

Harry C. Solomon, M.D. 
Chief of Therapeutic Research. 

REPORT OF THE CHIEF EXECUTIVE OFFICER 

To the Medical Director of the Boston Psychopathic Hospital: 

On December 1, 1931, the beginning of the fiscal year 1932, Dr. Arthur N. 
Ball, the former Chief Executive Officer of this hospital, was appointed Director of 
the Division for the Examination of Prisoners, and the present Chief Executive 
Officer was appointed to take his place. To facilitate the administration of the 
hospital Dr. Ball kindly carried on for a month the executive duties with the present 
Chief Executive Officer. For this courtesy we are greatly indebted to Dr. Ball. 

Early in the year a survey of the hospital was made with the cooperation of the 
Engineering Staff of the Department of Mental Diseases. As a result of this sur- 
vey certain changes in the physical make-up of the hospital building were con- 
sidered with the view of facilitating the operation of certain departments. 

The methods of preparing and serving food were studied and found to be not 
at all satisfactory. As a result, the idea of a cafeteria for employees was given 
considerable thought and tentative plans for the installation of cafeteria equipment 
were drawn up by the Engineering Department. Later on in the year, by carefully 
studying the budget, it was found it would be possible to transfer certain funds 
from various headings in order to establish a sum sufficient to pay for the installa- 
tion of the equipment. Permission for this was given by the Department, the 
Budget Commissioner and the Comptroller. 

The cafeteria at present is almost completed and it is hoped that it will start to 
function early in December. The installation of such equipment not only will 
give the hospital employees better prepared and a greater variety of food, but it 
can be shown definitely that money can be saved under Personal Services by 
creating vacancies in the positions which are now occupied by waitresses in the 
six dining rooms which are being abolished by the establishment of the cafeteria 
and the Staff Dining Room. There is no question but that waste of food stuffs 
will be greatly reduced. 

This marks the first step in what the Chief Executive Officer considers a three 
year program. The next step in this program will be the re-allocation of the store 
room adjacent to the kitchen. By taking the dining room, formerly used by the 
porters and employees in the kitchen, as a store room, all food stuffs can be cen- 
tralized in quarters adjoining the kitchen. This step releases the old storeroom 
which is one of the largest rooms in the building. It is proposed to change over 
this room and make it into a record room. Another room conveniently located on 
the basement floor is to be used for a file room. The present file rooms has been 
fijled to overflowing and it is necessary to find suitable quarters to cover present 
needs and necessary expansion for a period of several years. It is hoped money 
will be available under Repairs and Renewals for the coming year to provide all 
new equipment for the preparation of records which will do away A\*ith the obsolete 
form of taking histories and notes in long hand. This should increase greatly the 
efficiency of the record room staff. 

The third step proposed is to make the old record room into a medical office. 
This will provide adequate desk room for the entire medical staff with the ex- 



P.D. 137 



33 



ception of the chiefs of services who will have private offices, one on the second 
floor and one on the third. The present file room is to be made into four rooms 
which will be used in the double capacity of dictating booths and rooms for inter- 
viewing relatives. This move releases the four physicians' offices on the second 
and third floors. One of these offices is to be made into a medical examining room 
with proper appartus and equipment. Another room is to be occupied by the 
Superintendent of Nurses. The Chief Medical Oflicer will be given one of these 
rooms, which in turn will release his office to Ward B, for which it was originally 
intended. In the remaining office on the second floor the dentist will be installed. 
This will give him larger, more convenient and more suitable space for his work. 
The Chief Executive Officer likewise expects to move his present office in order 
that it may be used as a part of Ward A, as was originally intended. Dr. Solomon 
will move his office to space adjacent to Ward A, which will centralize the Depart- 
ment of Therapeutic Research under his direction on the first floor. The oflfice 
space formerly occupied by the Superintendent of Nurses and Dr. Solomon's 
department will be turned over to the Psychological Department for necessary 
expansion. A study of these various changes shows that they can be made with 
little or no extra appropriation of funds, and in all probability can be included 
under our usual budget requirements. Various departments in this way can be 
centralized and coordinated in such a way that they should function in a smoother 
and more efficient manner. 

During the course of the year the Out-Patient Department has been re-decorated 
and a Psychological Nursery has been established. The woodwork of the pavilion 
on the fifth floor has been scrubbed and painted with aluminum and white paint. 
The Assembly Hall has been redecorated. The kitchen and hallways in the base- 
ment have been re-painted. New equipment in the nature of a water-cooled ultra 
violet light has been added to the Physiotherapy Department. Brine pipes have 
been recovered and other minor repairs carried out during the year. 

Through the kind co-operation of the Street Commissioner of Boston, Vila Street 
has been accepted and re-surfaced, and its name changed to Vining Street. New 
manholes have also been added in this territory which will greatly help our sewage. 

I wish to express at this time my sincere appreciation to the Medical Director, 
heads of departm.ents and all employees of this hospital for their co-operation and 
loyalty. To Dr. Kline, the Commissioner of the Department of Mental Diseases, 
Mr. Merrill, the Business Agent, and all the members of his staff, I am particularly 
indebted for the aid and advice without which I would have been unable to accom- 
plish any of the changes which I have undertaken during this, my first year, at the 
Boston Psychopathic Hospital. 

Respectfully submitted, 

Samuel Smith Cottrell, M.D. 

Chief Executive Officer. 

REPORT OF SOCIAL SERVICE DEPARTMENT 

To the Medical Director of the Boston Psychopathic Hospital: 

As during the preceding year there have been few changes in staff. In March 
1932, Mrs. Ruth Kozol resigned, her place being filled immediately by Miss Doris 
Stolzberg, a graduate of Radcliflfe College and Simmons School of Social Work. In 
August 1932, Miss Clara F. Swain who had been with the department for two years, 
went abroad to study. After a delay of a month Miss Helen Spurrier, a graduate 
of Smith School of Social Work, was engaged to fill her place. Two Smith School 
of Social Work students, namely, Miss Louise Silbert and Miss Alice Fellows who 
were here from September, 1931 to June, 1932 and Miss Bertha London, who was 
a volunteer worker for several weeks, completed the staff and enabled it to handle 
a larger number of active cases than last year. 

While the total number of new cases for the year, namely, eight hundred and 
seventy-four is less than that of last year which was nine hundred and thirty-eight 
the number of cases for intensive care has increased. For instance; four hundred 
and seven patients as against three hundred and sixty were visited and supervised 
in the community. Some of these cases had been discharged from the hospital 



34 



P.D. 137 



wards as non-psychotic or not sufficiently ill to need further care and others had 
been referred to the Out-Fatient Department. The number of visits pertaining 
to the supervision of these cases, exclusive of the interviews made in the process 
of the investigation of court and House cases was 1,290, an increase of almost 500. 
The Out-Patient statistics seem to indicate much the same type of situation. While 
not as many people have come to the clinic as in other years, each has reported a 
greater number of times. 

An analysis of the social problems which have appeared in the total number of 
cases handled by the Social Service Department indicates that there has been an 
increase of eighty in problems of mental disease, of one hundred and fourteen in I 
personality problems, of sixteen in legal problems, of thirty-six in sex problems,, 
of ninety-five in financial difficulties and of twenty-one in employment problems. 
A casual survey does not give any clue as to why there has been an increase of mentall 
problems, but it does show definitely that the ' depression*' is causing difficulty 
for the patients. 

In the actual distribution of the work routine, the same policy has been carriedl 
on this year as last, namely, certain workers have confined themselves to certaini 
specific tasks. There ha?, been an attempt however, to supervise a larger group of 
ward patients after their discharge. Many of these cases if not supervised by the 
Social Service Department of this hospital would have gone back to the same stresses 
and strains in their environment as those from which they had come. In order 
to make the period of hospitalization of any benefit it seems wise to attempt to 
help these individuals in their community adjustments. 

Social case work has been defined as follows: '"Social case work is a conscious] 
attempt to improve the health, stability, comfort, efficiency and satisfaction of an 
individual by changes in him, his environment or both." 

While it is rather difficult to show that certain treatment deals only with the^ 
attitude of the individual or only with the environment, it is apparent in some' 
instances that more emphasis has been placed on effecting a change of environment I 
than effecting a change in patient, or vice versa. The following cases are given to • 
illustrate changes in environment, a field which is particularly that of the case • 
workers as the physician is not able to leave the hospital environs in order to bring 
about an easement of the home or work situation. The improvement in the sur- 
roundings has seemed to cause improvement in patient's condition and delayed < 
further hospitalization. 

A.M., a single person of 35, had been having excessive sexual ruminations of the 
wish fulfillment type, centering around a male associate at her place of employment 
for two years. She finally gave up her job because of her inability to concentrate 
on her work. An intolerably drab home life with a high-tempered father of whom 
patient was afraid, no friends because patient was too tired at night after she had 
climbed the long hill from the car to her home to entertain socially or go out, con 
tributed towards the development of her psychosis. When she left the hospital 
she had ceased to be hallucinated and had gained somewhat physically. Recom- 
mendation was made that she must have more recreational life, should have 
employment which was not too fatiguing, should get away from home if possible 
so that she could make friends and be awayifrom the domination of her father, i 
Patient was under social service supervision for nine months. Employment in I 
a co-operative workshop where the industrial conditions were not too difficult 
was found for her. Although the pay was small she was glad to accept it as she 
was the only wage earner in the family, both her father and brother being out 
of work. While the employment did' not bring her many new friends it did give 
her something to talk about at night with her mother. A vacation of two weeks 
was arranged during the summer at a camp run by a local social organization. 
Patient improved greatly here, making new friends and completely relaxing. 
She herself said after the first week, "There seems to be nothing wrong with my ■ 
mind. It was no effort for me to keep happy and busy." After many unsuccessful 
attempts, lodgers were found, providing income and permitting patient to live 
away from home. 

G.M., a single woman of 29, admitted to the hospital following suicidal threat. 
History indicated that her father was dead. Her mother had supported her for 



P.D. 137 



35 



years. She herself had graduated from high school, then stayed at home for about 
ten years and then had entered a theological college. Here she had conflict over 
her race, she being a negress and was rundown physically because of endocervicitis. 
During her hospital residence there was much nervous tension but much dramati- 
zation of her difficulties. She was found committable but left against advice as 
her mother did not wish her to go to another hospital. She was readmitted in two 
months after she had again threatened suicide. She enumerated many complaints 
and on this occasion was called a neurasthenic of the mixed type. Hospital com- 
mittment was again advised but the mother again refused to follow out this sug- 
gestion. 

Patient has been under social service supervision for six months, at the same time 
having intensive psychotherapy by the doctor. Social service has attempted to 
improve the relationship with her mother. Patient has always been very unsym- 
pathetic toward her mother, taking great pride in being cruel and domineering. 
Through acting as an audience for patient's story of difficulties with her family the 
latter has been released from much unpleasantness. The sympathy and the atten- 
tion which she has received plus the contacts with physician have satisfied the pat- 
ient's desire to be the centerof the stage and have prevented further hospital residence. 

R.T., another case which illustrates "manipulation of the environment" came 
through the Out-Patient Department. He is a boy of 8, referred by his school 
principal because of overactivity, emotional tension and general naughtiness, 
thought to be due to wrong handling by his unwise mother who repeatedly told 
him that he would be insane like his father. Investigation revealed the following: 
Patient and his parents had been living in a very dark, damp, dirty home of two 
rooms, a kitchen and a bedroom. There was no yard where the patient could play. 
There were no decent children in the neighborhood with whom to play. There 
was much traflSc which prevented patient from going to school alone. The father 
was a cardiac case who usually lose employment every year because of arthritis 
which necessitated hospitalization. City aid had to be given during this time. 
He had a high average intelligence, was music loving and fond of reading. The 
mother was approaching menopause, was of low grade intelligence, had no interest 
in appearance of her home. She had cut herself off from her family because they 
had disapproved of her marrying Protestant and a low paid stammerer. She liked 
to make a sensation of patient's misbehavior and her marital dissatisfaction. 
Patient had normal endowment, was popular with his mates, capable of handling 
his own affairs but was troubled with enuresis. 

Case was under social service supervision for over a year during which time 
certain environmental changes were effected. At the instigation of social service 
worker family moved into a better neighborhood with less traffic where patient 
could go to school alone and be away from the over-solicitous attitude of his mo- 
ther and where he had playmates. A better house provided two bedrooms and 
their own bathroom and a yard where the patient had rabbits. A radio, a bird 
which the father gave the mother for her birthday, comfortable chairs and a side 
board added much to the father's comforts. It is almost impossible to know to what 
to attribute improvement but with the above changes the father got through the 
winter without illness and city aid. He returned to church and the men's club. 
The mother resumed relationships with her own family, increased her outside in- 
terests so that she would not have as much time to spend criticizing the patient. 
Patient was sent to camp for the summer where he began to grow up and proved 
to be a "manly stalwart youngster." 

The next two cases illustrate an attempt to change the attitude of the patient 
as well as improving the environment. 

N.Y., age 19, was admitted July 9, 1931 and discharged July 15, 1931 following 
a period of depression and feeling of inadequacy. She was readmitted in September 
following more threats of suicide, remained for twelve days, discharged and re- 
admitted in November at which time she remained over a month. 

History indicated that her father had deserted when she was a baby. Her 
mother had placed her with foster parents with whom she had lived until a year and 
a half before admission. The foster mother died and the foster father's relatives 
forced him to give up the patient, depriving her of her father substitute. She had 



36 



P.D. 137 



had no responsibility until this time. She was unsuccessful in finding pleasant 
work, having an unhappy period as an attendant in a mental hospital. When she' 
came to the hospital she thought no one liked her and she was queer. After her first 
residence she was discharged to the care of her sister who proved to be a very badi 
influence. Sister was working in a Chinese restaurant and having illicit relations' 
with the Chinamen. She introduced patient to them. Sister's husband, a ne'er- 
do-well forced patient to have sex relations with him which resulted in pregnancy. 

While much effort and time was spent by the social service department in re- 
leasing patient from the sister's domination, in arranging for boarding care, in 
planning for prenatal and delivery care, a great effort was expended in getting 
patient to change her attitude toward herself and her surroundings. Many 
therapeutic talks were held with the patient at the home for unmarried mothers 
where she was sent. While the patient seemed very shallow emotionally it was 
possible to change her attitude somewhat and to make her a better mother for her 
child. , 

R.B., age 17, was admitted because she had become excitable at her employer's 
home, had seen someone in her room when there was no one there and had threatened 
to jump out of the window. Her father had been committed to jail for adultery. 
Mother had low intelligence quotient, questionable relationship with boarders and 
long history of drinking. Patient had been arrested for stealing, having been 
taught the art of stealing by an aunt and another girl. At times she was said to 
be moody, to want to be by herself, to not talk pleasantly with employers. On 
other occasions she told exaggerated stories of father's wealth and her own life in a 
private boarding school. A diagnosis of potential schizophrenia or pathological 
personality was made. 

Patient was under supervision for a year, being seen as often as once a week by 
social worker. She was encouraged to talk over her problems and explain her 
views on life. She could have done the same with the physician but she did not 
wish to come to the Out-Patient Department. She finally confessed that she had 
strong homosexual trends and had had many overt experiences. Following these 
she had her periods of seclusiveness and moodiness. 

At one time patient indicated a desire to marry a man whom she thought was ' 
several years older than herself. It was discovered that he had a long court 
record and was a minor. She was aided to face the fact and to give him up without 
having any resentment '"toward an interfering social worker". At the end of ; 
the year, at which time she was employed, she stated that she had improved a great 
deal during the year. She realized her manners were more gracious, that she did 
not swear as much as formerly, that she was not as "hard-boiled". She had more ^ 
insight into her behavior. It was felt that constant contact with the worker whom j 
she liked had increased in her a desire to improve herself. 

No report seems complete without some discussion of the court cases. This 
year it is possible to make some interesting comparisons with the cases referred by 
the courts in 1929 as a thesis was written about the latter by Miss Ethel Goodwin 
who was with the department from July, 1928 until September, 1980, leaving then 
to enter the New York School of Social Work, She made a study of the relationship 
of the hospital diagnosis, the hospital recommendations and court action. 

In 1932, two hundred and thirty-six cases were referred by the courts as against 
one hundred and forty-six in 1929. One-fifth of the 1932 cases as against one- 
eighth of the 1929 cases were referred because of drunkenness; one-sixth as against 
one-eighth because of assault and battery. There seemed to be very little increase 
in cases sent for sexual olfenses but many more were referred because of neglect of 
family or non-support of wife. One-fifth of the 1932 cases were under twenty years 
of age as against one-sixth in 1929 and one-eighth as against one-tenth were over 
fifty. 

Two other theses were written last year, one on a follow-up of thirty-six delin- , 
quent children referred to the Out-Patient Department in 1928, Special attention 
was paid to whether or not the recommendations of the hospital had been carried 
out and if so, if these recommendations had any relationship to improvement in the 
patient. Seventeen cases were found to be making satisfactory adjustment when 
followed in 1931. The old problems for which they were referred to the clinic had 



P.D. 137 



37 



disappeared and there were no new problems. In seven of these cases the recom- 
mendation had been made that the child be sent to an industrial school. Only two 
of the families had been willing to carry out these suggestions but due to a change 
in the family set-up the patients seemed to get along well. In this first group the 
referring agencies helped the families when it was not possible to carry out hospital 
recommendations. Fourteen children were not improved. They went to either 
State hospitals, correctional institutions or industrial school. These cases had 
always presented more serious problems. They were delinquent for longer lengths 
of time. There was bad emotional tone in the family. In this last group three cases 
who had been recommended for foster home placement were allowed to stay in 
their own homes. There was no correlation between improvement and the number 
of contacts with psychiatrist and social worker. In the cases where there was the 
worst adjustments there had been the most visits to the hospital, but this does 
not prove necessarily that short contacts are more successful; merely indicates 
that complicated problems do not respond to intensiv^e care. 

Miss Louise Silbert prepared a dissertation on record writing, and outlined a 
sample form to meet the needs of the psychiatrist and social worker. She surveyed 
the literature written during period from 1915-1932 and discussed the evolution 
of the records at this hospital. 

Students at Emerson College have acted as hostesses in the Out-Patient Depart- 
ment during the year. They have spent their time playing with the children and 
reading to them. In addition to helping to make less tedious the time cf waiting 
they have made many useful observations regarding the behavior of the patients. 

A small sum of money which was given by the Junior League in place of Christmas 
greens was used to buy a typewriter for a boy who could not read and some new 
clothes for an adolescent girl who had had little else than hand-me-downs. 

At this time I should like to express appreciation of the excellent co-operation 
given this department by all members of the staff. 

Respectfully submitted, 

EsT?'Ei{ C. Cook, 

Head Socuil Worker. 



SOCIAL SERVICE STAFF 
Head Social Worker: Esther C. Cook, July 1, 1928. 

Asshtants in Social Service: Rena Dewey, August 25, 1930. Ruth Kozol, March 
21, 1931 - resigned, March 12, 1932. Annie Porter, October 13, 1930; Helen 
Spurrier, October 5, 1932. Doris Stolzberg, March 14, 1932. Clara Swain, October 

I, 1930 — resigned, August 27, 1932. 

Syphilis Follow-up Worker: Ruth Epstein, September 30, 1930. 

SOCIAL SERVICE STATISTICS 
The full report of the Syphilis Service is given elsewhere but to the total number 
of cases handled by the Social Service Department may be added 104 new cases 
handled by the Syphilis Service social worker. 
I. Numerical summary: 

Male Female 
f • .1' ' hiliiren Adnltx 

New caaes . 11.} 58 211 

Renewed from previous year . 33 34 13 45 

Continued from previous year. 30 18 20 35 

Total carried during year 874 

Closed during year .156 275 m; 

Continued to following year 20 41 5 8 874 

II. Sources of new cases: 

House . 373 
Out-patient 257 
Research 16 
Sources of continued ras« s: 

House 36 
Out-Patient 61 



38 



P.D. 137! 



Research 7 

Sources of renewed cases: 

House 44 

Out-patient 73 

Research 8 

III. Analysis of work on all cases: 

Number of histories 107 

Number of investigations 285 

Number of patients on visit from hospital books .... 65 

On visit (exclusive of syphilis service) 13 

All others (including house cases which have been discharged 

into the community and out-patient cases) .... 407 
Number of visits pertaining to the supervision of patients in 
the community, either ex-house cases or out-patient cases 

(does not include visits made during course of investigation) 1290 

Number of visits to patients on wards 344 

Placements by Social Service: 

1. Unable to place 17 

2. Number placed 33 



Unclassified: Steering for agencies, application sent to school 



for feebleminded, getting interpreters, etc. 

IV. Outstanding social problems: 

Diseases: 

Mental 488 

Physical 160 

Personality problems, including temperament, vacillating in- 
terests, instability, etc 420 

Legal problems, including larceny, assault, forgery, etc. 146 

Sex problems 150 

Environmental: 

Financial difficulties 243 

Employment 118 

Marital difficulties 131 

Unsuitable surroundings, broken home, friction in the 
home, inadequate physical surroundings, immoral parents 256 

V. Miscellaneous: 

Expense account $733 .78 



REPORT OF THE PRINCIPAL OF SCHOOL OF NURSING ' 

To the Medical Director of the Boston Psychopathic Hospital: 

I herewith present the annual report of the nursing department for the year 
ending November 30, 1932. 

On nursing service — Principal, School of Nursing, 1; Assistant Principal, School 
of Nursing, 1; nurse instructor, (full time), 1; female supervisor, (night), 1; male 
supervisor (day), 1 ; assistant supervisors, 2; head nurse, operating room, 1; head 
nurses, wards, 6; assistant head nurses, 2; post-graudate nurses, 2; students 
nurses, 14; hydrotherapists, 2; female attendants, 8; male attendants, 13. 

Head nurse resigned — Mrs. Margaret Lundy; appointment. Miss Madaline 
Peddle. 

During the year we received fifty-four student nurses and two graduate nurses 
for the three months course in psychiatric nursing. 

We still retain the affiliation we established six years ago with the Faulkner, 
Cambridge, Newton and New England Baptist Hospitals; and four years ago 
with the New England Deaconess Hospital. The Lynn Hospital with whom we' 
established affiliation last year is now sending us four students nurses instead of 
two every three months. We also accepted two students from the Westerly Hospital 
Westerly, Rhode Island, during the summer affiliation. This helped to cover 
the shortage due to vacations. We were unable to continue this affiliation due to 
the overcrowded condition in the nurse's quarters. 

Miss Marion Hammond and Miss Lena LaBadia graduates from the Ellis 



„ P.D. 137 39 

ii 

Hospital, Schenectady, New York, are taking a post-graduate course. These nurses 
are obliged to room out as we have no means of housing them. 

The affiliative course taken by Miss Helen Beeler and Miss Avice Ansty, students 
from the Faulkner Hospital was interrupted due to illness; both nurses returned 
later for one month, completeing their course. 

We had more than the usual amount of illness throughout the nursing depart- 
ment: due partly to a case of diphtheria and the subsequent quarantine of the 
hospital wards for several weeks. Miss Anna Pease haed nurse on Ward 3 and Miss 
Muriel Kew, assistant nurses on Ward 2 showed positive throat cultures and were 
confined to the South Department of the Boston City Hospital for three weeks. 

The nursing problem of taking care of an increased number of excited physically 
ill patients during the year, while having less than our usual quota of nurses due to 
illness, was rather a difficult one, and I wish to thank the doctors for their help and 
cooperation, without which we could not possibly have carried on. 

Hydrotherapy — tonic baths, number of patients, 227; foot baths, 557; salt 
glows, 958; electric light baths, 662; saline baths 141; sitz baths 196; hot and cold 
to the spine 138; tub shampoos 533; head shampoos 436; needle sprays 3,301; 
fan douches 3,301; jet douches 1,2 45; rain douches 396; Scotch douches 106; 
massage 52: continuous baths, number of patients 218; number of baths 667; 
numbe of hours 3,465. Wet sheet packs: number of patients 26; number of 
packs 47; number of hours 115. Out-I atient Department: — number of patients 
21; foot baths 43; salt glows 61; electric light baths 214; needled sprays 328; 
fan douches 328; jet douches 273; scotch douches 38; massage 101. Instructions 
in wet sheet packs, continuous baths and tonic baths were given to 54 student 
nurses. Number of lessons 702: number of hours 702. Instructions in wet sheet 
packs and continuous baths were given to 10 male attendants. Number of lessons 
37, number of hours 46. 

Respectfully submitted, 

Mary Fitzgerald, R. N. 

Principal, School of Xursing. 

REPORT OF THE DEPARTMENT OF OCCUPATIONAL THERAPY 

To the Medical Director of the Boston Psychopathic Hospital: 

During the year the work of the Occupational Therapy Department has pro- 
ceeded, in essential features, along previous lines. With the routine work, how- 
ever, we have endeavored to introduce variety and create interest, so that there 
is something of benefit offered to every patient. The benefit is not always to 
apparent among short term patient?, but with long term patients, it is naturally 
more so. That this is true is shown by the occasional return of discharged patients, 
to work in the department. 

For eight months in the year we continue to have students from the Boston 
School of Occupational Therapy. With us they receive part of their training with 
mental patients and we are always glad to have their interest and enthusiasm. 
While they are with us it is possible to maintain more specialized work on Ward 
III, under the supervision of the assistant. From the therapeutic point of view this 
first contact with the patients is most valuable, and if they later come to the de- 
partment tends to a more co-operative attitude. 

The affiliated nurses also spend a certain part of their allotted time at the hos- 
pital in our department. They learn the principles and routine of the work and 
are most helpful if any emergency arises. 

So far the recreational side of our program has been limited to holiday dances, 
for which we make appropriate decorations. This affords a pleasing diversion and 
makes for excellent group work. 

In connection with the annual meeting of the Massachusetts Occupational 
Therapy A.«wociation, in November, samples of our work were exhibited, and the 
director had the pleasure of serving on the Exhibition Committee. 

The personnel of the department is unchanged, Miss Maynard continuing as an 
able and loyal a.^sistant. 

The statistics of the Department are as follows: 

Attentance Women — average attendance, 15; total enrollment, 626. 



40 



P.D. 137i 



Attendance — Men — average attendance, 20; total enrollment, 783. 
Articles made, 1,448. Forms prited, 20,540. 



Respectfully submitted, 

Alice E. Waite, 



Head Occupational Therapist. 



PUBLICATIONS FROM THE CLINICAL SERVICE AND LABORATORIES 

Beck, S. J. — The Rorschach Test as Applied to a Feeble-minded Group. Col- 
umbia University, Archives of Psychology, No. 136, 1932. 

Bowman, K.M. and Bexder, L. — The Treatment of Involution Melancholia 
with Ovarian Hormone. American Journal of Psychiatry, Vol. XI, No. 5, 
March 1932. 

Bowman, K. M. — Progress in Psychiatry for 1931. Nezv England Journal oj 

Medicine, Vol. 207, No. 16, pp. 701-707, October 20, 1932. i 
Campbell, C. Macfie — The Schizophrenic Territory and the Task of Mental 

Hygiene. ' Gehrmann Lectures on Hygiene, University of Illinois College of 

Medicine, March, 1932. 
Epstein, S. H. and Dameshek, W. — Involvement of the Central Nervous 

System in a Case of Glandular Fever. New England Journal of Medicine, 

Vol. 205, No. 26, p. 1238, Dec. 24, 1931. 
Epstein, S. H. and Marvin, F. W. — Observations on Pentobarbital Sodium 

in Lumbar Punctures, Convulsive and Manic States. Neiv England Journal 

of Medicine, Vol. 207, No. 6, p. 258, August 11, 1932. 
Epstein, S. H. — Chemotherapy of Neurosyphilis. Rhode Island Medical Journal,' 

Vol. XV, No. 11, p. 175, November 1932. 
Grabfield, G. p. and Pratt, J. H. — The Action of Cinchophen. Journal of^ 

Pharmacology and Experimental Therapy, Vo. XLII, No. 4, August 1931. 
Grabfield, G. P. and Campbell, A. G. — A Note on the Relation Between 

Blood Cholesterol and Basal Metabolic Rate. New England Journal of 

Medicine, Vol. 205, No. 24, December 10, 1931. 
Meredith, L. and Solomon, M. H. — The Trend Study. News Letter, Ameri-; 

an Association of Psychiatric Social Workers, Vol. 1, No. 4, January 1932. 
Solomon, H. C. and Epstein, S. H. — Encephalography under Narcosis Pro-; 

duced by Non- Volatile Anesthetics. Journal of American Medical Association,- 

Vol. 98, p. 1794, May 12, 1932. 
Wells, F. L. — Army Alpha-Revised. The Personnel Journal, Vol. X, No. 6,. 

pp. 411-417, April, 1932. ; 
Wells, F. L. — Evaluation of Personality and Character Tests. American \ 

Journal of Orthopsychiatry, Vol. II, No. 4, October 1932. 



VALUATION 



November 30, 1932 
Real Estate 



Land, 2 acres 
Buildings 



$59,300. 00| 
527,042.64 



$586,342.64 



Personai. Property 



Travel, transportation and office expenses 

Food 

ClothinR and materials 
KurnishinKs and household supplies 
Medical and general care .... 
Heat and other plant operation 

Farm 

(iarage and Rrounds 

Repairs 



$3.816. 18 
1,786. 17 
1.659 57 
25,488,91 
21,144.61 



911.88 



133.20 
1,261.23 



$56,201.75 



Summary 



Real estate 



$586,342.64 
56,201.75 



$642,544.39 



p.D. 13: 



41 



FINANCIAL REPORT 
To the Department of Mental Diseases: 

I respectfully submit the following report of the finances of this institution for 
the fiscal year ending November 30, 1932. 

Cash Account 

(The receipts shown below are to be on a strictly cash basis of what has been actually turned in to the 
Treasury of the Commonwealth.) 
Receipts 

Iwome 

Board of Patients . . $7,522.35 
Reimbursements 376.28 



Personal services: 

Reimbursement from Board of Retirement 

Sales: 

Food 

Furnishings and household supplies 

Repairs, ordinary' 

Arts and crafts sales . 
Sundries . 



Total sales 
Miscellaneous: 

Interest on bank balances 

Rent 

Sundries 



35.82 
7 00 
6 46 
58 10 
11 95 



$120.31 
1.200.00 
422.25 



Total income 



Balance from previous year, brought forward . 
Appropriations, current year . . . . 



.M.\t.NTENA\CE 



Total 

Expenses (as analysed below) 

Balance reverting to Treasury of Commonwealth 

Aniilyxif of Ei-ptJisn 

Personal services 

Religious instruction ... 
Travel, transportation and office expense- 
Food 

Clothing and materials .... 
Furnishings and household supplies 
Medical and general care . 
Heat and other plant operation 
Garage and grounds . 
Repairs ordinary- 
Repairs and renewals 



Total expenses for maintenance 



$7,898 63 
$88 83 



119 33 



1.742.56 
$9,849 35 



$5,573 74 
235.450 00 

$241,023 74 
231.176 62 

$9,847.12 



$161,662 73 
1.160 00 
5.126 26 
26,977 66 
536 36 
4.881 43 
13.716 05 
12.101 .94 
248.70 
3.315.81 
1.449 68 

$231,176 62 



Per Capit.\ 

During the year the average number of inmates has been 79.81. 

Total cost of maintenance. $231,176.62. 

E^jual to a weekly per capita cost of $55.7036. 

Receipt from s-iles. $1 19.,<.<. 

Equal to a weekly ix-r capita of $.0287. 

All other institution nteipt.s. $9,730 02. 

E'lual to a weekly per capita of $2.3445. 

Net weekly per capita $53.3304 

Respectfully submitted, 

Elizabeth Libber Shore, 



Treasurer. 



STATISTIACL TABLES 
As Adopted by the Amehh an Phvchiatric As.soriATioN Prescribed 

BY THE Ma8SACHU8ETTK DEPARTMENT OK MeNTAL D|8EA»E8 

Table 1. General Information 

Data correct at end of hoHpital year November 30, 1932 



June. 1912. 



Date of openino as a ho«pital for mental dincuKi 
T : ■ • V • ' State. 

I ■ 

f" >roperty: 
uding buildwiK'* 
r< I ~'>iuil property 



hocpital property owned. 2 Acres, 
ider cultivation during previous year, 2 mt- 



t^Mf..<42 64 
.M)I .75 



42 



P.D. 13i 



4. Oflficers and employees: 

Actually in Service Vacancies at End 

at End of Year of Year 

M. F. T. M. F. T. 

Superi^itendents 2 - 2 

Assistant physicians 10 - 10 1 - 1 

Medical internes 3 1 4 - - - 

Clinical assistants 2 1 3 - - - 



Total physicians 17 2 10 1 - 1 

Resident dentists 1 - 1 

Graduate nurses 2 12 14 - 2 2 

Other nurses and attendants .... 16 17 33 - - - 

Occupational therapists - 2 2 

Social workers - 6 6 - - - 

All other officers ai^d employees ... 24 45 69 2 - 2 



Total officers and employees ... 60 84 144 3 2 5 

Note: — The Jollowing items. 5-10 inclusive, are for the year ended, September 30, 1932. 
5. Census of patient population at end of year: 

Absent from Hospital 
Actually in Hospital but Still on Books I 

White: M. F. T. M. F. T. 

Insane 32 27 59 20 26 46 

Epileptics - 1 1 - - - 

Mental defectives 2 1 3 - - 

Alcoholics . . 1 1 2 

All other cases 6 4 10 



Total 41 34 75 20 26 46 

Other Races: 

Insane 2 1 4 2 - 2 



Total 3 1 4 2 - 2 

Grand Total 44 35 79 22 26 48 

M. F. T. 

6. Patients under treatment in occupational-therapy classes, including 

physical training, on date of report 25 16 41 

7. Other patients employed in general work of hospital on date of report .2 - 2 

8. Averagedaily number of all patients actually in hospital during year 41.78 38.42 80. 2(! 

9. Voluntary patients admitted during year 34 f 28 62 

10. Persons given advice or treatment in out-patient clinics during year . 536 646 1.182 

Table 2. Financial Statement 
See Treasurer's report for data requested under this table. | 

Note: — The following tables 3-19, inclusive, are for the statistical year ended September 30, 1932. 



P.D. 137 









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44 P.D. 137 



Table 4. Nativity of First Admissions and of Parents of First Admissions 



Nativity 


Patients 


Parents of Male 
Pateints 


Parents of Female 
Patients 
































Both 






Both 




M. 


F. 


T. 




Fathers 


Mothers 


Parents 


Fathers 


Mothers Parents . 


United States. .... 


46 


31 


77 


18 


16 


12 


15 


17 


14 


Austria ...... 


1 




1 


1 


1 


1 


1 






Canada ' ..... 


- 


4 


4 


4 


6 


4 


5 


5 


3 


England ...... 


2 


2 




5 


6 


4 


- 


1 




Germany ...... 




















Greece ...... 


1 






1 


1 


1 








Ireland ...... 




7 




10 


10 


8 


17 


13 


13 




■2 
J 


1 




^ 


5 


5 


2 


2 


2 


Norway 


1 






2 


1 


1 








Poland 


1 






1 


1 


1 








Russia 


2 


1 




6 


6 


6 


5 


6 


5 


Scotland 


2 


2 




4 


2 


2 


1 


2 


1 


Sweden 




1 






1 




3 


2 


2 


Turkey in Europe. 


1 






1 


1 


1 








West Indies .... 


2 




2 


1 


2 


1 








Other countries .... 


2 


3 


5 


5 


2 


2 


3 


3 


3 


Unascertained .... 








1 


2 












64 


52 


116 


64 


64 


50 


52 


52 


44 



'Includes Newfoundland ^Except Cuba and Porto Rico 



^D. 137 



45 




46 



P.D. 137 



Table 5 Citizenship of First Admissions 



M. F. 

Citizens by birth 46 31 

Citizens by naturalization 12 12 

Aliens S 7 

Citizenship unascertained 1 2 

Total 64 52 

Table 6. Psychoses of First Admissions 



Psychoses 



1. Traumatic psychoses 

2. Sen'ile psychoses 

3. Psychoses with cerebral arteriosclerosis 

4. General paralysis 

5. Psychoses with cerebral syphilis . 

6. Psychoses with Huntington's chorea . 

7. Psychoses with brain tumor . 

8. Psychoses with other brain or nervous diseases, to'tal 

Meningitis, tubercular or other forms . 
Other diseases 

9. Alcoholic psychoses, total .... 

Delirium tremens 

Acute hallucinosis 

10. Psychoses due to drugs and other exogenous toxins, total 

Opium (and derivatives), cocaine, bromides, chloral, ( 
combined 

11. Psychoses with pellagra 

12. Psychoses with other somatic diseases, total 

Delirium of unknown origin 

Cardio-renal diseases 

Other diseases or conditions 

13. Manic-depressive psychoses, total 

Manic type 

Depressive type 

14. Involution melancholia .... 

15. Dementia praecox (schizophrenia) 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses, total . 

Hysterical type 

19. Psychoses with psychopathic personality . 

20. Psychoses with mental deficiency 

21. Undiagnosed psychoses .... 

22. Without psychosis, total .... 

Total 



alone or 



M. F. T. 



M. F. 



1 2 

2 2 

9 12 

8 15 



8 12 
1 
1 
1 



64 52 116 



Table 7. Race of First Admissions Classified with Reference to Principal Psychoses 



Race 



African (black) 

Armenian . 

English 

German 

Greek 

Hebrew 

Irish 

Italian ' 

Lithuanian. 

Scandinavian* . 

Scotch 

Slavonic » . 

Syrian 

Turkish 

Mixed. 

Race unascertained 
Total . 



Total 



M. 



64 52 116 



Traumatic 



M. F. T. 



With 
cerebral 
arterio- 
sclerosis 



M. F. T. 



1 1 2 



General 
paralysis 



M. F. T. 



1 - 1 

1 - 1 

1 - 1 

5 1 6 



4 35 4 39 



With 
brain 
tumor 



M. F. T. 



2 - 



'Includes "North" and "South". 
^Norwegians. Danes, and Swedes. 

'Includes Bohemian, Bosnian, Croatian, Delmatian, Herzegovinian, Monenegrain, Moravian. Polish, 
Russian. Ruthenian, Servian, Slovak, Slovenain. 



?.D. 137 47 



Table 7. Race of First Admissions Classified with Reference to Principal 

Psychoses — Continued 



Race 


With other 
brain or 
nervous 
diseases 


Alcoholic 


Due to druii^s 
and other 
exogenous 
toxins 


With other 
somatic 
diseases 


Manic- 
depressive 




M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M. 


F. 


T. 


M. 




T 


\frican (black) .... 


















1 




1 


1 




I 


\rmenian 




















1 


1 




_ 




English 


2 


1 




3 








1 1 


~ 


3 


3 


2 


5 


7 


jerman 
























1 




1 


^reek 






























lebrew 


























2 


2 


rish 




1 




1 










1 


4 


5 


1 




1 


talian ' 






























-^itbuanian 






























vrandinavian ' .... 




1 




1 






















scotch 
















1 1 








1 






Slavonic 












1 


1 
















Syrian 






























Turkish 






























Mixed 


1 


2 




3 


1 




1 






1 


1 




1 


1 


R.ace unascertained 


















1 




1 






I 


Total 


3 


5 




8 


1 


1 


2 


- 2 2 


3 


9 


12 


7 


8 


IS 



Table 7. Race of First Admissions Classified ivith Reference to Principal 
Psychoses — Concluded 



R.\LK 


Involution 
melancholia 


Dementia 
praecox 


Paranoia 

and 
paranoid 
conditions 


Epileptic 
psychoses 


Psycho- 
neuroses 

and 
neuroses 


Undiagnosed 
psychoses 


African (black) 

AriTR-nian 

.>h . 


M. F. T. 


M. F. T. 
1 4 5 


M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


i.tn . 
•w 
,11 1 

:.inian . 


1 1 


3 1 4 
2 2 4 
1 1 2 

1 1 


1 1 


1 1 


1 1 


1 1 2 

2 1 3 

1 1 


linavian- 










:iic' 














I uriiish . 
Mixed . 

Race unascertained 
Total 




1 3 4 










- 1 1 


8 12 20 


- 1 1 


- 1 1 




3 4 7 



'Includes "North" and "South". 
JNorwegians. Danes, and Swedes. 

'Includes Bohemian. Bosnian. Croatian. Delmatian. Herzegovinian, Montenegrin, Moravian, Polish, 
Russian, Ruthenian. Servian, Slovak, Slovenian. 



48 
















P.D. 137 


Table 8. Age of First Admissions Classified with Reference to Principal Psychoses 










Under 




15-19 




20-24 


Psychoses 




Tota 


1 


15 years 




years 




years 




M. 


F. 


T. 


M. F. T. 


M. 


F. 


T. 


M. F. T. 




1 


_ 


J 






























3. With cerebral arteriosclerosis . 


1 


3 


4 












4. General paralysis 


35 


4 


39 


- 2 2 


1 


_ 


1 


— — _ 


5. With cerebral syphilis .... 












_ 




_ _ _ 




















7. With brain tumor 


2 


_ 


2 


_ _ _ 


_ 


_ 


_ 


_ _ _ 


8. With other brain or nervous diseases 


3 


5 


8 


_ _ _ 


1 


1 


2 


_ 


9. Alcoholic 


1 


1 


2 












10. Due to drugs and other exogenous toxins 


_ 


2 


2 






























12. With other somatic diseases . 


3 


9 


12 












13. Manic-depressive 


7 


8 


15 


_ _ _ 


_ 


1 


1 


1 4 5 


14. Involution melancholia .... 


- 


1 


1 










- - - 




8 


1 2 


20 




1 


2 


3 


4 2 6 


16. Paranoia and paranoid conditions . 




1 


1 
















1 


1 


1 1 










18. Psychoneuroses and neuroses . 




1 


1 






1 


1 




19. With psychopathic personality 


















20. With mental deficiency .... 


















21. Undiagnosed psychoses .... 


3 


4 


7 






1 


1 




22. Without psychosis 


















Total 


64 


52 


116 


- 3 3 


3 


6 


9 


5 6 11 



Table 8 Age of First Admissions Classified with Reference to Principal 
Psychoses — Continued 









25-29 






30-34 






35-39 






40-44 






45-49 






Psychoses 




years 






years 






years 






years 






years 








M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


1. 


Traumatic .... 














1 




1 














2. 


Senile 
































3. 


With cerebral arteriosclerosis 














1 


















4. 


General paralysis . 


2 




2 


6 




6 


5 


2 




3 




3 


4 




4 


5. 


With cerebral syphilis . 
































6. 


With Huntington's chorea . 
































7. 


With brain tumor. 
































8. 


With other brain or nervous 


































diseases .... 




1 


1 








1 












1 


2 


3 


9. 


Alcoholic .... 
















1 










1 




1 


10. 


Due to drugs and other exo- 


































toxins 






















2 


2 








11. 


With pellagra 
































12. 


With other somatic diseases 




2 


2 




1 


2 




1 
















13. 


Manic-depressive . 
















1 










2 


1 


3 


14. 


Involution melancholia 






















1 


1 








15. 


Dementia praecox. 


1 


4 


5 


2 


1 


3 




2 


2 










1 


1 


16. 


Paranoia and paranoid con- 


































ditions 
































17. 


Epileptic psychoses 
































18. 


Psychoneuroses and neuroses 
































19. 


With psychopathic person- 


































ality 
































20. 


With mental deficiency 
































21. 


Undiagnosed psychoses 


1 




1 










1 


1 


2 


2 


4 








22. 


Without psychosis 


































Total .... 


4 


7 


11 


9 


2 


11 


8 


8 


16 


5 


5 


10 


8 


4 


12 



>.D. 137 



49 



Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses — Concluded 



Psychoses 


50-54 
years 


55-59 
years 


60-64 
years 


65-69 
years 






JVl. 




T 


i>l. 


IT 
V . 


T 
I • 


JVl. 




T. 


M. F. T. 


1 . 
























2. 
























J. 


W ith ccrcbrsl arteriosclerosis 






1 




1 


] 








- 1 1 


4. 




o 




8 


A 




4 


2 




-> 

L 


_ _ — 




























With Huntington's chorea .... 


























2 




2 
















i. 


With other brain or nervous diseases. 
















1 

1 


1 
1 


_ _ _ 


























[). 


Due to drugs and other exogenous toxins 






















1. 


With pellagra 






















2. 


With other somatic diseases 


- 


2 


2 


2 


3 


5 










1 

J. 




1 


t 

1 


■) 
i. 


_j 














4. 
























5. 
























5. 


Paranoia and paranoid conditions 




1 


1 
















7. 
























?. 


Psychoneuroses and neuroses 






















). 


With psychopathic personality . 






















3. 
























. 


















































Total 


11 


5 


16 


9 


4 


13 


2 


1 


3 


1 1 



50 



P.D. 13 



^ ^ ^ I CSJ 



^ 1 (S U~, 



11 



vO tN — -H 



to S 



lifiii 

c3 rt c ix: 



3 rt r a 



7^ ;^ "3 

u X 2 ^ c .y o u .2 

C O ^ g rtjCtS 



O O' 



B 4> 

I c 



£|S|S5:S-6|£l 

orto!-uxioooaO(^ 

O W'S'^ 'S 



^D. 137 



51 



""able 10. Environment of First Admissions Classified with Reference to Principal 

Psychoses 



Psychoses 




Tota 


1 


Urban 






M. 


F. 


T. 


M. 


F. 


T. 


l_ 




1 




1 


1 






2. 
















3. 


With f^f^rf^hra] prt ^^rir^cr'lpfnQic 


1 


3 


4 


1 


3 


4 


4 


General psrslysis 


35 


4 


39 


35 


4 


39 


5 
















6. 


With Huntington's chores 














7 


With hrairi t \imr\T 


2 




2 


2 




2 


8. 


With Other hrciin or nervous disesises 


3 


5 


8 


3 


5 


8 


9 




1 


1 


2 


1 




2 


o! 


J— 'UC Ultimo CtllU ^JLllCl ^■^^g^^ll^Uo LLIAlllS ...... 




2 


2 




2 


2 


1. 


With pellagra 














2. 


With other somatic diseases 


3 


9 


1 2 


3 


9 


12 


3. 


Manic-depressive 


7 


8 


15 


7 


8 


15 


4. 


Involution melancholia 






1 




1 


1 


5. 




8 


12 


20 


8 


12 


20 


6. 


Paranoia and paranoid conditions 




1 


1 




1 


1 


7. 






1 


1 




1 


1 


8. 


Psychoneuroses and neuroses 




1 


1 




1 


1 


9. 


With psychopathic personality 














0. 


With mental deficiency 














1. 


Undiagnosed psychoses 


3 


4 


7 


3 


4 


7 


2. 


Without psychosis 
















Total 


64 


52 


116 


64 


52 


116 



Cable 11. Economic Condition of First Admissions Classified zuith Reference to 

Principal Psychoses 



Psychoses 




Tota 


1 


Dependent 


Marginal 


Un'certained 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 




F. T. 


1. Traumatic 


1 




1 








1 




1 






2. Senile 
























3. With cerebral arteriosclerosis 


1 


3 


4 








1 


3 


4 








35 


4 


39 


2 




2 


33 


4 


37 






5. With cerebral syphilis .... 
























6. With Huntington's chorea 


























2 




2 








2 




2 






8. With other brain or nervous diseases 


3 


5 


8 




1 


1 


3 


4 


7 






9. Alcoholic 


1 


1 


2 








1 


1 


2 






0. Due to drugs and other exogenous toxins 




2 


2 










2 


2 






1. With pellagra 
























2. With other somatic diseases 


3 


9 


12 








2 


9 


11 


1 


1 




7 


8 


15 








7 


8 


15 






4. Involution melancholia .... 






1 












1 








8 


12 


20 


1 




1 


7 


12 


19 






6. Paranoia and paranoid conditions 






1 












1 






7. Epileptic psychoses .... 






1 












1 






8. Psychoneuroses and neuroses 






1 


















9. VVMth psychopathic personality 
























lO. With mental deficiency .... 
























11. Undiagnosed psychoses .... 


3 


4 


7 








3 


4 


7 






12. Without psychosis ... 
























Total 


64 


52 


116 


3 




4 


60 


51 


111 


1 


1 



52 



P.D. 13! 



Table 12. Use of Alcohol by First Admissions Classified wtih Reference to Principi 

Psychoses 



Psychoses 



Traumatic .... 

Senile 

With cerebr)al arteriosclerosis 
General paralysis . 
With cerebral syphilis . 
With Huntingtoh's chorea . 
With brain tumor. 
With other brain or nervous 

diseases .... 

Alcoholic 

Due to drugs and other exo 

genous toxins 
With pellagra 

With other somatic diseases 
Manic-depressive . 
Involution melancholia 
Dementia praecox 
Paranoia and paranoid conditions 
Epileptic psychoses 
Psychoneuroses and neuroses 
With psychopathic personality 
With mental deficiency 
Undiagnosed psychoses 
Without psychosis 

Total .... 



Total 



M. 



64 



52 



116 



Abstinent 



M. F. T. 



26 44 70 



Temperate 



M. F. T. 



2 - 
1 2 



27 



Intem- 
perate 



M. F. T. 



1 1 



9 1 10 



Unascei i 
tained 



M. F. T 



Table 13. Marital Condition of First Admissions Classified with Reference to 

Principal Psychoses 



Psychoses 



1. Traumatic .... 

2. Senile 

3. With cerebral arteriosclerosis 

4. General paralysis . 

5. With cerebral syphilis . 

6. With Huntington's chorea . 

7. With brain tumor . 

8. With other brain or nervous d 

eases 

9. Alcoholic .... 

10. Due to drugs and other exogenous 

toxins 

11. With pellagra 

12. With other somatic diseases. 

13. Manic-depressive . 

14. Involution melancholia 

15. Dementia praecox 

16. Paranoia and paranoid conditions 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses 

19. With psychopathic personality 

20. With mental deficiency 

21. Undiagnosed psychoses 

22. Without psycliosis 

Total 



Total 



M. 



52 



116 



Single 



M. 



3 2 
1 



8 11 19 



27 27 54 



Married 



M. F. T. 



- 3 3 
24 1 25 



2 - 



6 7 

1 4 

1 1 

1 1 



30 19 49 



Separated Divorced 



M. F. T. 



1 - 

3 - 



- 1 
1 1 



1 1 



M. F. T. 



1 1 



1 1 



2 4 6 



.D. 137 



53 



Table 14. Psychoses of Readmusions 

Psychoses Males Females Total 

eneral paralysis 4 - 4 



iychoses due to drugs and other exogenous toxins - 1 1 

anic-depressive psychoses 3 6 9 

ivolution melancholia - 2 2 

ementia praecox 1 1 2 

sychoses with psychopathic personality - 1 1 

sychoses with mental deficiency - 1 1 

ndiagnosed psychoses 1 - 1 

Total 9 12 21 



ABLE 15. Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge 



Psychoses 



Total 



Improved 



M. 



Traumatic 

Senile 

With cerebral arteriosclrosis 

General paralysis 

With cerebral syphilis 

With Huntington's chorea . . . . 

With brain tumor 

With other brain or nervous diseases 

Alcoholic 

Due to drugs and other exogenous toxins 

With pellagra 

With other somatic diseases 

Manic-depressive 

Involution melancholia . . . . 
Dementia praecox. . . 

Paranoia and paranoid condition 

Epileptic psychoses 

Psychoneuroses and neuroses 

With psychopathic personality . 

With mental deficiency . . . . 

Undiagnosed psychoses . . . . 

Without psychosis 

Total 



20 



M. F. T. 



23 



20 3 23 
1 1 



37 19 56 32 18 50 



["able 16. Causes of Death of Patients Classified with Reference to Principal 

Psychoses 











General 


Manic- 


*A11 other 


Causes of Death 




Total 


paralysis 


depressive 


psychoses 




M. 


F. 


T. 


M. F. T. 


M. F. T. 


M. 


F. T. 


Epidemic, Endemic and Infectious Diseases 
















iberculosis of the respiratory system 




1 


1 








1 1 


'philis (non-nervous forms) .... 


1 




1 


1 - 1 








irulent infection, septicaemia. 


1 




1 






1 


1 


Diseases of the Nervous System 


















1 




1 






1 


1 


ther diseases of spinal cord .... 


1 




1 




1 - 1 






erebral hemorrhage, apoplexy. 




1 


1 








1 1 


eneral paralysis of the insane. 


2 


1 


3 


2-2 






1 1 


ther forms of mental diseases. 




1 


1 








1 1 


Diseases of the Circulatory System 
















ndocarditis and myocarditis .... 


1 


1 


2 






1 


1 2 


Diseases of the Respiratory System 


















1 


2 


.\ 


1 - 1 






2 2 






1 


1 








1 1 


Total 


8 


8 


16 


4-4 


1 - 1 


3 


8 11 



♦Includes group 22, "without psychosis". 



Tj* CO 


h 1 


1 1 - 1 


1 - 


1 ' 





CN 


yeai 


to 1 


1 1 - 1 


1 - 

' ' 


1 1 1 1 1 1 1 
1 1 1 1 1 1 1 


1 1 1 1 1 
1 1 1 1 1 




0\ CO 


H • 


1 1 1 1 




1 1 CN 1 1 1 1 


1 1 1 1 1 






to 1 


1 1 1 1 




1 1 1 1 1 1 








IS 1 


III! 




1 1 « 1 1 1 1 


1 • 1 1 1 




7! 




1 1 - 1 




1 1 ^ 1 1 1 1 







1 C3 
O ^ 


to 1 


1 1 1 1 




1 1 (N 1 II 1 


Ill'' 


CN 




1^ 1 


11-^1 


' ' 


1 1 1 1 1 1 1 


1 1 1 1 1 






H 1 


1 1 1 1 


1 - 


1 1 1 - 1 1 1 





CN 


T « 


to' 1 


1 1 1 1 


1 - 


1 1 1 1 1 1 1 


1 1 1 1 1 








1111 




1 1 1 ^ 1 1 1 







Tj> cn 




1 1 - 1 










T« 


to 1 




, , 


^ 


1 1 1 1 


(N 
















O CO 


H ' 




:: 


::::::: 


I 1 1 - 1 




7^ 


to' 1 




1 1 


1 1 1 1 1 1 1 


11111 




30-34 
years 


to 1 


1 1 1 




11-1111 


■ 1 1 1 I 

1 1 1 1 1 


CN 
CN 


0> CO 














1 

ts >■ 


to 1 


1.11 

111! 




1 1 1 1 1 1 1 

1 1 1 1 1 1 1 


1 1 1 1 1 


1 
' 


Tl" CO 
















to ' 
S ' 


III. 

1 1 1 1 




1 1 1 1 1 1 1 

1 1 1 1 1 1 1 


1 1 1 1 1 

1 1 1 1 1 


1 


0> CO 








'i ! 'i ! i ! 


I 'l 'l 'l 'l 'l 




15-1 
yeai 


to 1 

i 1 


1 1 1 1 

I 1 1 1 




1 1 1 1 1 1 1 


1 1 1 1 1 1 








1 1 1 


1 1 ro 


„ 1 ir: ^ 1 1 1 


1 1 1 1 CS 1 


o 


Tote 


to 1 




1 1 fN 


1 fTI 1 1 1 1 


1 1 1 1 <N 1 


00 






1 1 'i" 1 




1 1 CN — 1 1 1 




00 



o 



>> 

O C 



- !^ >< 



iz 35 2 CJ ^ 

e-^-^ y>c.^ 'fi 2 

: 5 "5 <y ;i u oj S-a 
caOioc'^T-i^cnO- ^O 

^ <n <V C ^ O O-Z^ 

M u ^- - O. C n "-^ 5 «J w 



5 c S-x " " o 



D. 137 



55 



iBLE 18. Total Duration of Hospital Life of Patients Dying in Hospital Classified 
According to Principal Psychoses 











Less than 


1-3 


4-7 


Psychoses 




Total 


1 month 


months 


months 




M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M. F. T. 


Traumatic ....... 


















Senile ........ 


















With cerebral arteriosclerosis 




















4 


- 


4 


2 


— 


2 


_ _ _ 


2-2 


With cerebral syphilis. .... 


















With Huntington's chorea. 


















With brain tumor 


















With other brain or nervous diseases 


1 


2 


3 


1 


2 


3 
























Due to drugs and other exogenous toxins 


_ 


1 


1 


- 


- 




1 1 


_ _ _ 




















With other somatic diseases 


2 


3 


5 


2 


1 


3 


1 1 


I 1 


Manic-depressive 


1 




1 


1 




1 






Involution melancholia .... 


















Dementia praecox 


















Paranoia and paranoid conditions 


















Epileptic psychoses 


















Psychoneu roses and neuroses 


















With psychopathic personality. 


















With mental deficiency .... 


















Undiagnosed psychoses .... 




2 


2 




2 


2 
























Total 


8 


8 


16 


6 


5 


11 


- 2 2 


2 1 3 



Public Document 



No. 137 



SItfF Ql0mm0ttmFalttj of iMaBaartjUBrttB 



ANNUAL REPORT 

OF THE 

TRUSTEES 

OF THE 

^ , Boston Psychopathic Hospital .i,^^ 

FOR THE 

Year Ending November 30, 
1933 

Department of Mental Diseases 




Publication of this Document appkoved by the Commission on Administkation and FiNANt.-B 
650. 3-"34. Order 785. 



OCCUPATIONAL PRINTINO FLANT 
OtPARTMCNT OF MENTAL DISEASES 
OAMONtH STATI COLONY 



BOSTON PSYCHOPATHIC HOSPITAL 

[Post Office Address: 74 Fenwood Rd., Boston, Mass.] 

Btim^ TRUSTEES 
William Healy, M.D., Chairman, Boston. 
Mrs. Esther M. Andrews, Secretary, Brookline. 
Carrie I. Felch, M.D., Boston. 
Channinq Frothingham, M.D., Jamaica >Plain. 
Allan W. Rowe, Ph.D., Boston. 
William J. Sullivan, Boston. 
Charles F. Rowley, Boston. 

CONSULTING PHYSICIANS 
E. B. Goodall, M.D., Ophthalmologist. 
G. Philip Grabfield, M.D., Internist. 
Leon E. White, M.D., Oto-Laryngologist^ 
Abraham Myerson, M.D., Neurologist. 

E. B. Sheehan, M.D., Gynecologist. 
John Rock, M.D., Obstetrician. 

J. H. SwARTz, M.D., Dermatologist. 
T. A. Marlow, Internist. 

The staffs of adjoining hospitals 

OFFICERS OF THE HOSPITAL 
C. Macfie Campbell, M.D., Medical Director. 
Arthur N. Ball., M.D., Acting Chief Executive Officer. 
Karl M. Bowman, M.D., Chief Medical Officer. 
Robert Fleming, M.D., Senior Physician. 
G. Philip Grabfield, M.D., Senior Physician. 
Edqarton M. Howard, M.D., Senior Physician. 
John P. Powers, M.D., Senior Physician. 
Oscar J. Raeder, M.D., Senior Physician. 
Harry C. Solomon, M.D., Senior Physician. 
John A. Abbott, M.D., Assistant Physician. 
Emeline p. Hayward, M.D., Assistant Physician. 
Joseph W. Owen, M.D., Assistant Physician. 
Mary Palmer, M.D., Assistant Physician. 
Charles B. Sullivan, M.D., Assistant Physician. 
Waldo W. Wynekoop, M.D., Assistant Physician. 
Raymond J. Duffy, M.D., Medical Interne. 
William F. Green, M.D., Medical Interne. 
William L. Holt. M.D., Medical Interne. 
GR03VFN0R r». Pt-j ARSON, M.D., Mcdicol Interne. 
Kathri n L. Scfult7, M.D., Medical Interne. 
Paul, H. Wilcox, M.D., Medical Interne. 

; , Chief of Neuropathological Laboratory. 

Anna M. Allen, yL.I>., Acting Chief of Neuropathological Laboratory.^ 
Whitman K. Coyvw, M.D., Roentgenologist. 
Petsk J. D^LTOp^; D.M.I*., Dentist. 

F. L. Wells, Ph.D., Head Psychologist. 

Mary Fitzgerald, R.N., Principal of School of Nursing. 

Esther C. Cook, Head Social Worker. 

Alice E. Waite, Head Occupational Therapist. 

Mrs. Elveretta Blake, Librarian. 

Elizabeth Libber Shore, Treasurer. 



>By arrangement with the Department of Mental Diseases. 



P.D. 137 ' A ^ 

CONTENTS ^ 

Page 

Report of Trustees 3 

Report of Medical Director 3 

Report of Chief Executive Officer 16 

Report of Out-patient Department 17 

Report of Chief Medical Officer 23 

Report of Biochemical Laboratory 25 

Report of Psychological Laboratory Zl 

Report of Neuropathological Laboratory 30 

Report of Department of Therapeutic Research 30 

Report of Social Service Department .34 

Report of Principal of the School of Nursing 39 

Report of Department of Occupational Therapy 40 

Publications from the Clinical Service and Laboratories 40 



REPORT OF THE TRUSTEES OF THE PSYCHOPATHIC HOSPITAL 
To His Excellency the Governor, and the Honorable Council: 

Once again we would draw your attention to what we conceive to be a very 
interesting document, the annual report of the Boston Psychopathic Hospital for 
1933, As Trustees, we have a great feeling of pride in the excellent accomplishment 
of that institution. 

In the report many interesting matters are covered, such as the effect of the 
economic depression upon the incidence and character of the mental upset that 
brought patients to the hospital. Incidentally, the need for economy has been 
reflected in some limitations of work done but we are happy to say that these have 
not been very extensive, very acute, and not altogether insuperable. On the 
whole, the nature and amount of work done at the hospital does not vary greatly 
from year to year. 

Again there would be some difficulty in choosing as most outstanding the accom- 
plishment of the various departments. Dr. Solomon's service has a national 
reputation; the work of the psychological division under Dr. Wells has certain 
unique values; the work of the general staff has in a remarkable way the confidence 
of the members of the medical profession and of the public generally. All depart- 
ments are kept busily engaged by the great intake and rapid turnover of patients. 

You may note that several chiefs of divisions speak of cramped quarters. This 
continues to be a handicap. 

The Medical Director, with his broad outlook upon the problems of mental 
disease, has once more set forth in succinct case histories the complex factors that 
go to produce a mental breakdown. Perusal of these shows how vital it is to 
continue investigative and therapeutic effort along many lines. 

The Trustees have regretted deeply during this past year the loss of Dr. Kline 
and of our own Chief Executive Officer, Dr. Cottrell. 

To the Medical Director of the hospital and his staff we continue to be grateful 
for the fine scientific and humane spirit which is displayed at all times at the 
hospital. 

Respectfully submitted, 
William Healy, Chairman William J. Swllivan 

Esther M. Andrews, Secretary Channinq Frothinqham 

Carrie I. Felch Charles F. Rowlbt 

Alla.v W. ItowE. Trustees. 

MEDICAL DIRECTOR'S REPORT 
To the Board of Trustees of the Boston Psychopathic Hospital: 

In accordance with the provision of the statutes I submit for your consideration 
the report for the statistical year ending September 30, 1933 and for the fiscal year 
ending November 30, 1933. 

On the General Wofik of the Ho.hpital 
During the past year the Boston Psychopathic Hospital has continued to carry 
out its three main functions, (1) as a health unit specially designed to meet the 
needs of patients with special handicaps and disabilities: (2) as a centre of invest- 



4 



P.D. 137 



isatiTe activity, auiyinc on research into the imderiyins causes of nervous and 
iMBtal disordcfs, with speoMl intereet in their prevoition; (3) as a cmtre of in- 
stniction where physicians and other professional workers learn to deal with the 
theoretical and practical aspects of nervous and mental disordos. 

The nature oi the dinical work at the hospital does not change very much frc r 
yeartoyearasitis detenninednotby the special interests of any group of physidar 
but by the actual disorders of the patimts who are brought to the hospitaL T: 
genoal run of these disordos does not alta* considerably, although general change 
in social habits and conditions are reflected to a minor extent in the admissicr.- 
to the hospitaL During the years of prohibition the change in drinking habits 
and the eztmsiTe bootlegging familiarized the physicians with clinical pictures 
somewhat different from those doe to the drinking habits b^ore prohibition. 

The prolongation of the economic d^ression has also, to a certain extent, been 
reflected in the dinical work of the hospitaL Individuals who had been able to 
cany on for a reasonable period undo- conditions of economic stringency would 
finally break down. Patioits who in normal times would have been looked after 
at home or outside of the hoqHtal would be referred to the hospital for treatment, 
Unemi^ymeBt not only contributed to the final breakdown of many individuals 
but also made it difficult for the physidans to re-establish the patient in his natural 
environment by arranging for some suitable occupation. 

The fundamental problems, however, which involve the greatest strain on human 
nature are not the frank and open difficulties of maintaining economic independence, 
but rather the intimate problems of peratmal value and of personal relationships 
with regard to which the individual is often thrown back upon himsdf and with 
whidi he is not accustomed to deal in a vigorous and wholesome manner. 

The sources from which the Boston Psychopathic Hospital derives its cases re- 
main ai^roximately the same. Some patients come spontaneously to the hospital 
for help, recognizing that they have some nervous condition which requires in- 
vestigation and willing to come to a hospital iHiich is situated in the neighbcr- 
hood of a vaiiety <rf general hospitals. Some patients do not recogmze their need 
or do not have enough spontaneity to take steps about it, but are brought by their 
relatives or their physicians or are transferred from general hospitals. The sim- 
plicity of the procedure necessary for admiwnon to the Boston Psychopathic 
Hospital has the great advantage of making it possible for a patient with an 
incqMent mental disorder to obtain help at the earliest period and with the minimum 
ofastades. Elaborate formalities which in the past have been required as safe- 
guards to prevent any suuster interference with the liberty of the subject are slowly 
coming to be seen in their real light as serious handic^is in the way of early treat- 

BesidBB those cases iHiich come to the hospital on account of obvious nervous or 
mental disorden, either recognized by the patient or by the relatives, there are 
other patients with regard to whom a medical opinion is requested although the 
problem which they present is not prima fade medicaL Thus during the past 
year there has been an increasing number of cases referred by the courts and by 
the police for a psydiiatric opinion on the condition of the individuaL It is ver>' 
gratifying to think that, in dealing with problems of public order and the admin- 
istration of justice, the anthimties are becoming progressively more alert to the 
fact that disorden of behaviour may be the symptoms of some underlying defect 
or ailment and so frequently take steps to have this possibility considered before 
they dispose in a statutory way of the individual and his conduct. 

Welfare organizations abo frequently refer their wards to the hospital although 
the primary problen may be dependency, neglect of chfldren, irregular and inferior 
lives, marital disharmony; they a n^>ect that these sodal manifestations may be 
the surface ezpr ea si on of important underlying mental defects or disorders. Workers 
in welfare agencies reaHze that for good case work it is frequently n ecessa ry to 
have selected m e m be is of a family leiie w ed from the psychiatric standpoint. The 
school authorities, too, realize that the disciplinary problems of the schoolroom 
and the lack of pi o gi cs s of the chfld can sometimes only be adequately dealt with 
after one has carefully s ur ve ye d the child and the home. In some children con- 
genita] ^yphiliB, an old attadc of encephalitis, some disorder of the internal glands 



P.D. 137 



5 



may explain the lack of normal mental development. In other cases the trouble 
may lie in some peculiar handicap such as the specific difficulty in learning to read 
which is characteristic of some children. In others the problem is not some char- 
acteristic of the individual as an isolated unit but is due to the special relationship 
between the child and other members of the family, whether this special relation- 
ship be a bond of disproportionate affection or, on the other hand, a latent hostility 
and antagonism. 

During the past year a successful endeavor has been made to establish still 
closer relations than before with the social agencies dealing with the various aspects 
of human relation and bringing comfort and support to individuals and households 
somewhat overwhelmed by the complexities of the modern environment. 

The work done by the hospital represents much more than the study and treat- 
ment of a number of clean-cut disorders; it represents a large measure of cooper- 
ation with other social agencies dealing with complex personal and family problems. 

The statistical tables included in this report present the work of the hospital 
under somewhat formal headings, which represent the technical medical classifi- 
cation of the patients. These technical tables may fail to give to the laymen any 
clear impression of the concrete work done by the hospital and of the variety of 
problems represented by individual patients. In order to fill out the skeleton of 
these statistical tables one may in this, as in previous reports, give a brief state- 
ment of the actual problems presented by patients. The following cases represent 
a consecutive series taken at random. 

A. B., aged 59, an Irish laborer, an extremely quiet man of limited interests and 
few friends, had some months previously been discharged on account of his drinKing 
habits. After a prolonged drinking bout the patient began to hear voices: he 
complained to the police of imaginary annoyances and was brought to the hospital. 
The patient cleared up in a few days and was able to return home ten days after 
admission. 

In such a case one has to consider not merely the poisonous effect of alcohol 
upon the nervous system, but the cause of the alcoholic indulgence. Alcoholic 
indulgence is not a problem merely of individual psychology but involves many 
social factors; in the present case one had to consider what facilities in the cultural 
environment were offered to the patient for living out a full human life and for 
enabling him to get wholesome satisfaction from his individual endowment. 

B. C., aged 39, an Irish laborer, was brought to the hospital because in an alcoholic 
excitement he had been threatening to kill the baby, had attempted to jump out 
of the window. The patient had been drinking to excess since the death of his first 
wife one year previously, during that time he had convulsive seizures. The patient 
cleared up rapidly after admission. He made light of his chronic alcoholism, did 
not seem in the least concerned about the fact that he had seizures, denied any 
memory of his outrageous behaviour when drunk. He showed no interest in dis- 
cussing the significance of his alcoholism and his wife took him away from the 
hospital against the advice of the physicians. 

In this case, as in the previous case, the complex social factors required investi- 
gation; from the more narrow medical standpoint the occurrence of convulsive 
seizures was of special interest. 

CD., aged 52, a skilled mechanic, was referred to the hospital by the court on 
account of an alleged sexual assault on a woman. The regular examination of the 
various bodily systems revealed no defect and the patient showed no signs of any 
mental disorder during his stay in the hospital. The marital situation was rather 
uncertain, the facts of the alleged assault not clear. The patient made accusations 
of infidelity against his wife, while, according to her story, he waa a man of ill- 
balanced sexuality. 

In such a case the hospital acts as adviser to the court and here it was only able 
to state that there was no convincing evidence either of mental disorder or of mental 
defect. The disposal of the case remained, therefore, a matter for the court to 
decide. Although there was no recognized mental disorder present, the sexual 
instinct had in this individual evidently presented a problem of unusual difficulty. 
The question arises how far early sex education would have prevented the marital 
discord and obviated the incident which brought him into court. 



6 



P.D. 137 



D. E., aged 52, a shoe- worker, was brought to the hospital on account of his be- 
haviour towards his family. He had a bad temper, threatened and abused various 
members of the family. No organic cause for his unstable behaviour and ill- 
balanced conduct was found and there was no evidence of any morbid ideas or 
hallucinations. The situation was one of considerable domestic friction, only 
partly due to the patient; the practical problem was to give the members of the 
family a somewhat more objective outlook and to encourage a mutually tolerant 
attitude. 

E. F., aged 46, a salesman owing to business reverses had attempted to commit 
suicide. On admission to the hospital he was mentally confused due to poisoning 
by carbon monoxide gas. In a week his general condition had become much better; 
his memory was still extremely poor, and he was transferred to another hospital 
for further treatment. 

F. G., aged 56, a printer, was admitted on account of progressive impairment of 
memory and increasing irritability. He had for two years suffered from convulsive 
seizures. The cause was organic brain disease which neither lent itself to operation 
nor to drug treatment. 

G. H., a lad of 17, who gave his age as 15, had behaved in a rather wayward 
manner in his boarding house. He had attempted to jump out of the window and 
was referred to the Boston Psychopathic Hospital. The boy gave a thoroughly 
untrustworthy account of his life. The Social Service Department made an in- 
vestigation through various social agencies and found out the real home of the boy 
in the middle West and had arrangements made for him to return home. The 
boy showed no evidence of any mental disorder. The problem was one of adjusting 
an atypical personality to the restrictions of social life. 

H. I., aged 31, a professional woman, since childhood had much difficulty in 
dealing with the sexual instinct. In the late twenties she had consulted a physician 
and a priest without benefit. Her difficulties continued and she passed into a 
condition in which she imagined that she was in communication with a variety of 
men, her behaviour became quite erratic and excited. The mental disorder was 
of a serious type and complete recovery was unlikely. Her sex difficulties seemed 
closely connected with the mental breakdown; there was no evidence that in her 
early life she had received any helpful advice or information in regard to this 
important topic. 

I. J., aged 61, a married woman, for three years had shown progressive memory 
defect, difficulty with speech, lack of personal cleanliness and care. The deteriora- 
tion was due to organic brain disease, secondary to thickening of the blood vessels. 

J.K., a lad of 20, was referred to the hospital by the court on a charge of lewd 
talk and behaviour. There was no evidence of any organic brain disease. Psy- 
chological tests showed that he was feebleminded. The community has to work 
out the problem how far it can assimilate and safeguard the defective individual, 
and what type of defective individual has to be looked after in special institutions. 

K.L., a lad of 20, was referred to the hospital by the court on account of peculiar 
ideas and behaviour. He was on probation at the court owing to a trifling larceny 
during the previous year. The patient showed a series of morbid ideas and claimed 
that he had been hearing many voices; he felt that he was hypnotized and that 
there had been complicated social maneuvers going on to his detriment. It was 
interesting to find that his brother and mother accepted the patient's statements 
and did not look on them as delusions. There was no evidence of any organic 
disorder of the central nervous system or other bodily systems. 

L.M., a girl of 20, was referred by the court where she had been brought on a 
charge of being idle and disorderly. She showed a condition of mental defect, with 
a mental age of eight years. In the hospital she was somewhat wayward, her be- 
haviour was rather odd. The problem seemed to be that of an individual with 
congenitally inferior endowment, unable to adapt herself to the demands of the 
ordinary social life. 

M.N., a man of 56, who had never married on account of his devotion to his 
mother, had for months been very much worried over business difficulties and 
finally developed morbid fears; he thought that he might be arrested, that poli- 
ticians were after him. 



P.D. 137 ' 
In a condition of this type stress is apt to be laid upon the external business 
difficulties but the condition may be closely related to the failure of the patient 
to live out a normal mature life, to internal tension and conflict, to unsatisfied 

insUncts^ man of 50, a chauffeur, belonged to a small and eccentric religious sect. 
Always a quiet man, he had recently become extremely preoccupied with religious 
topics and finally had behaved in a very erratic way; he had a morbid apprehension 
that something was going to happen. There was no physical condition to explain 
the change in his personality and the absurdity of his behaviour. In the hospital 
he did not wish to discuss with the physician the significance of his religious be- 
liefs nor the nature of his own personal difficulties. The patient was transferred 
for further care and treatment. . 

P a high school boy of 17, two years previously had a convulsive seizure. 
Ten days before admission to the hospital he began to feel vaguely unwell, six days 
later he had a convulsive seizure. On the following day for a brief period he showed 
a peculiar lack of repsonse to those around him. Interviews with the patient 
elicited the fact that his convulsive seizures had occurred under conditions of 
emotional tension. The first attack two years previously had occurred when he 
found that he was not to be promoted in school; the more recent seizure had oc- 
curred after a quite unusual quarrel with his sister. It appeared, therefore, as ij 
external situations as well as some special instability of the nervous system played 
role in the production of individual attacks. ^ _ 

P Q a bookkeeper, aged 59, for seven years had suffered from pernicious anaemia 
for three years he had diabetes. Two months before admission he began to worry 
and to talk of past misdemeanors; he was very agitated and clamored for for- 
giveness. His condition in the hospital was one of considerable agitation It 
appeared probable that with continuation of his medical regime and with an 
opportunity to review frankly his preoccupations, his condition would be con- 
siderably relieved. His wife, however, failed to cooperate in the program and he 
was removed after a few days in the hospital. ^ „ , • j 

Q R a woman of 40, was firmly convinced that her body was full of poison and 
that she had many serious symptoms, although a thorough review in a good hospital 
revealed no physical disorder. The mother of four children, she had throughout 
all her married life had friction with her alcoholic husband. It was difficult to 
trace the origin of her symptoms to her actual di^iculties. The patient was of 
shallow and ill-balanced constitution; for further treatment it seemed advisable 
to transfer her to another hospital. . 

R S a single woman of 32, was admitted on account of various bodily pains 
and mild depression. Her personality had changed since the interruption of a 
love afifair four years previously through the interference of a relative. She had 
become profane, less dependable, more interested in her personal appearance and 
had recently shown very erratic conduct, on one occasion leaving her house in 
pajamas and bathrobe. The patient at first made the impression of having a 
rather mild and dramatic reaction to sexual difficulties; but during her brief stay 
in the hospital her behaviour became much more erratic and ominous and the 
outlook for complete recovery was much worse. , , u u j 

S T., aged 48, was admitted to the hospital after she had threatened her husband 
and talked of suicide. For many years her conduct had been progressively more 
inefficient: she drank and was subject to attacks of excitement. In the hospital 
the patient showed little disturbance of behaviour, was somewhat unstable emo- 
tionally and circumstantial in her account of her life. She gave a history of a very 
unhappy home situation but it was not possible to determine whether she or her 
husband was the more to blame. She had been for many years accustomed to drink 
but claimed that she only drank with her husband. It seemed advisable to trans- 
fer the patient to another hospital for a somewhat longer period of observation 

T.U., aged 58, a mechanic, had for the past year been more difficult, irritable, 
jealous and at times abusive. The poor behaviour of the patient seemed to be due 
to organic changes in the bfain, partly due to chronic alcoholism, partly to an 
episode of carbon monoxide poisoning. 

The above consecutive series of cases gives a general sample of the patients ad- 



8 



P.D. 137 



mitted to the hospital, but some of the special problems presented by patients may 
be illustrated by a few other cases who were admitted at approximately the same 
period. 

U.V., aged 57, a glove cutter by occupation, for some years had suffered from 
gastric symptoms and had been treated in hospital. He was accustomed to take 
very large amounts of drugs for headache. Four months before admission he had 
been operated on for hernia. At that time his heart action was poor and required 
treatment. He was admitted to the Boston Psychopathic Hospital on account 
of mental confusion with visual hallucinations. In the hospital he quickly cleared 
up and was able to leave in a few days. 

V.W., a young woman of 24, after delivery in another hospital had severe 
bleeding, became delirious and excited, and was admitted to the Boston Psycho- 
pathic Hospital. After a few days she improved but the improvement was not 
maintained and the patient died suddenly eleven days after admission. 

W.X., a woman of 43, separated for over a year, had shown difficulty of gait 
and a change of personality and efficiency. There had been one convulsive seizure. 
The patient was found to be suffering from diffuse organic disease of the central 
nervous system for which no special treatment was available. 

X.Y., a married woman of 52, after an attack of pneumonia became confused 
and suspicious with somewhat variable mood. She heard voices, did not know 
where she was. There had been other physically reducing causes besides the 
pneumonia. The mental symptoms were apparently secondary to the physical 
impairment and during a week spent in the hospital the patient made marked 
improvement; it was thought wise to arrange for further stay in a state hospital 
until she should completely recover. 

Y.Z., a widow of 55, suffering from cancer of the uterus, had been depressed 
and attempted to commit suicide. The depression, however, was not related to 
worry about her physical condition but owing to the recent tragic death of her 
sister. The condition of the patient was one of pronounced depression and the 
patient required careful supervision so that she might not do herself any harm. 

A. Z., aged 29, had various nervous feelings from time to time, was easily startled, 
found it difficult to concentrate, was annoyed by obsessive ideas. A tonsillectomy 
had done her no good. The nervous symptoms seemed to be determined to a 
certain extent by personal conflicts in regard to the problem of marriage and eman- 
cipation from her mother. The treatment of the case did not require continued 
stay in the hospital, as a series of interviews could be arranged for in the out- 
patient department. 

B. Y., aged, 20, had a sudden episode of confused behaviour during which he 
returned home; later he had no memory of this episode. A review of the condition 
indicated that he was a somewhat sensitive boy, emotionally too dependent on 
his mother, and the above episode seemed to be determined by special emotional 
factors. 

These brief notes on the actual problems presented by the patients in the hos- 
pital illustrate the field which has to be covered by the physician. The individual 
patient needs not only a thorough review of the bodily functions but also an 
analysis of the personality and of the past experiences which have moulded it and 
a survey of the environmental situation with its stresses and its resources. 

The few cases reported above include individuals suffering from pernicious 
anaemia, from diabetes, from gastric ulcer, from complications after childbirth, 
from cerebral syphilis, from chronic alcoholism, from poisoning by carbon monox- 
ide, from prolonged use of various drugs, from vascular disease of the brain. The 
study of a mental disorder involves the same review of the physical condition of 
the patient as is required in the general hospital, and if the same level of efficiency 
is to be attained it is necessary that there should be the same equipment and per- 
sonnel for making the requisite special examinations. 

In addition to the review of the physical systems the physician has in the case 
of a mental disorder to analyze the personality, to study its special assets and lia- 
bilities, to study his special type of sensitiveness in order that the vulnerability 
of the patient may be reduced. 

It is not enough, however, to establish an equilibrium between the conflicting 



P.D. 137 



9 



"orces of the personality. It is advisable to see that the individual is not exposed 
to environmental strains beyond its powers of resistance; the individual must be 
helpied to utilize the cultural resources of and to derive support from the social en- 
vironment. 

In the cases briefly referred to above one sees the role played in the mental dis- 
order by disturbing domestic and social factors. One sees the importance of the 
relations between parents and children, between husband and wife, and between 
the individual and the social group. 

The complexity of the situation is such that a thorough examination involves a 
heavy expenditure of time. It is only in a few cases that such a detailed investi- 
gation can be made. In the majority of cases admitted to the hospital the review 
of the case does not go far beyond what is required in order to make a satisfactory 
diagnosis and to outline the further program of care and treatment. In a small 
number of cases it is possible to make a more intensive and thorough study. In 
some cases the study and treatment of the patient is carried on over a protracted 
period and is followed by careful supervisory work during the readjustment of 
the patient to life outside the hospital. 

0.\ THE Various Activities of the Hospital 
The care and the treatment of the patient can only be adequately carried out 
with the help of a well organized personnel. The bedside examination of the 
patient, the technical laboratory procedures, the ward care and nursing supervision, 
the special hydrotherapeutic procedures, the program of occupational activity 
require a number of technical assistants and their willing cooperation. 

The bedside examination of the patient is supplemented by the study in the 
laboratory of various functions and secretions. The report of the biochemical 
laboratory indicates the extent of these special examinations and something of 
their significance. 

In the care and ward treatment of the patients, besides the more technical pro- 
cedures of the physician an important factor is the influence exercised by the 
nurses and attendants. The role of the mental nurse is somewhat different from 
that of the nurse in the general hospital. There is less demand for purely technical 
and impersonal procedures, and more need for imagination and intuitive insight. 
The physician helps the patient overcome unwholesome repressions and to review 
frankly his total endowment, he furnishes reassurance and encourages the patient 
to go on with his task and to regain a feeling of security and personal value. The 
nurse in her daily contact with the patient is of great value in relieving fear and 
in giving reassurance, in modifying feelings of inferiority and encouraging feelings 
of personal worth. The nurse may do much to help the patient to reestablish 
contact with the social group, to feel a certain degree of solidarity with his fellows 
and to contribute what he can to the amenities of the social situation. The patient 
who is reticent with the physician may unburden herself to the nurse. 

In order that the nurse may carry on her task intelligently and not see it reduced 
to the dull level of mere custodial care she must have some insight into the me- 
chanisms of mental disorders, must grasp the significance of familiar symptoms, 
must understand the general trend of the medical treatment. The medical staff 
is bound to give the nursing group some insight into the disorders of the patients 
for whom they are daily caring. At the Boston Psychopathic Hospital there is 
constantly on duty a group of affiliated nurses from general hospitals who spend 
three months training in the hospital. During this period these nurses get a course 
of instruction in which the members of the s*;aff take a very active part. At the 
same time the chiefs of service have it as one of their functions to see that the 
nurses in charge of the various services have a sufficient realization of the pro- 
blems of the individual patients to be able to deal with them in the most helpful 
way. 

On the Department op OrcuPATiONAL Therapv 
In many cases no physical ailment keeps the patient in bed, the patient is physi- 
cally fit to go on with the ordinary conduct of life but is temporarily debarred 
from his ordinary program by the mental disorder. It is very important that while 
the physician is doing what he can to deal with the special disturbance of the patient 



10 



P.D. 137! 



he should encourage the patient to utilize as fully as possible the resources which! 
are still available. Compulsory idleness has a very deleterious eiffect on the normal; 
individual and equally so on many a case of mental disorder. Idleness fosters un- 
wholesome daydreaming, accustoms the individual to a passive and unproductivei 
attitude, represents a dependent and immature attitude rather than the wholesome 
independent attitude of the self-supporting and productive adult. From many 
points of view a good working program is of great importance for the patient. It 
increases self-respect and independence, it accustoms the individual to a wholesome 
output of energy, it brings in satisfaction from normal functioning and from pro- 
ducing articles of recognized quality. It gives an opportunity of producing material 
which is of value to the social group and which therefore does justice to the social 
needs of the individual. It has, in addition, the practical value of making it easier 
for the patient to step out from life in the hospital to a productive life outside; the 
patient thus escapes a trying period of readjustment to occupational demands. In 
some cases the occupation followed in hospital has a financial value to the patient, 
when he leaves or if not a financial value it may serve the role of a very useful hobby. 

During the past year the Occupational Therapy Department has continued to 
carry on its important function admirably as in previous years. 

On the Social Service Department | 
The care and treatment of a mental disorder involve more than a study and a 
readjustment of the isolated individual. The disorder itself may be a complicated 
problem of unsatisfactory adjustment to a complex social environment. The 
treatment may involve some modification of the environment if the improvement; 
of the individual is to be made permanent. With a patient in general hospital,, 
whose faulty circulation has been temporarily restored, it is poor economy to send 
him back to heavy mechanical work, under which the heart will certainly soon 
break down again. It is equally uneconomic to discharge a patient from a mental 
hospital without paying attention to the later tasks of the patient and considering, 
in what way the stresses and strains involved in the environment may be modified. 

It is frequently necessary, therefore, to consider the value involved in the homes, 
the neighborhood, the factory or office, the special social contacts of the individual. 
Such an investigation requires its own special technique and experience and it is 
the role of specially trained social workers to take up this investigation. Such 
an investigation makes it possible for the physician to estimate the factors which 
have led to the breakdown of the patient and enable him to outline the later 
program of the patient in a more profitable way. It may be necessary to modify 
the atmosphere of a home, to discuss many matters with the parents in order that 
a child may return to the home with a better chance of unimpeded development. 
In some cases it may be advisable to choose a substitute home. The social worker 
may have to interview the teacher in order that the atmosphere of the schoolroom 
may be more wholesome for the individual child or so that the contacts of the 
playground may not be unnecessarily disturbing. The social worker may enter 
into the home in order that marital relations may be placed on a better basis and 
so that the needs and interests of both parties may receive due recognition and so ' 
that unnecessary conflicts may be avoided. Similarly the resources of the com- 
munity may be more fully placed at the disposal of the patient through the worker's 
contact with employers, pastors, social organizations for recreation, employment 
or relief. Where a patient is referred by the court it is considered obligatory to 
make a thorough study of the social situation so that the special conduct of the 
individual may be seen on the background of the social situation and constructive 
suggestions made with regard to the issues involved. In the random sampling 
of cases given above the cooperation of the hospital with the court is illustrated. 

On the Work of the Out-Patient Department 
As medicine progresses prevention comes into the foreground of interest rather ' 
than the treatment of well established disorders. One of the chief aims of medicine 
is to eliminate those conditions which give rise to disease and which lend themselves 
to control by the community. In the treatment of disease more and more stress 
is laid upon the early recognition of disease and on treatment at the very earliest 
stage when the chances of recovery are most favorable. In the field of mental ' 



P.D. 137 



11 



disorders this tendency to make treatment available at the very earliest stage is 
aided by sweeping aside all restrictive regulations, by making both the laity and 
the general practitioner familiar with the early signs of mental disorder, and by 
helping the community at large to look at mental disorder in a frank and open way. 

It is important, therefore, that the mental hospital should not only be prepared 
to receive patients sufficiently sick to require treatment in a hospital, but should 
have consultation facilities available for those who have only some indication 
of a possible mental disorder or whose mental disorder does not interfere seriously 
with their carrying on normal domestic, social and occupational activities. 

The out-patient department of the hospital therefore has a very important func- 
tion. It is available for consultation with regard to any of the problems connected 
with mental disorders, and thus aims to forestall disaster and to treat the patient 
before a serious disorder has had time to be established. 

The report of the out-patient department shows from how many sources in the 
community patients are directed to it. In the endeavor to make the out-patient 
department of maximum usefulness and efficiency it has now been run for some 
years on an appointment basis. The patient is thus encouraged through a mini- 
mum expenditure of time to come to the hospital for a review of whatever symptoms 
demand attention. It has been found that the appointment system not only saves 
time but also enables much more intensive and consistent work to be done with 
the patients. 

This branch of the hospital helps many patients to carry on outside and be 
productive at home or in industry who, unable to carry on without such help, might 
have been admitted to the hospital. It also furnishes a point of contact with the 
patient who has left the hospital and who for a short time may report back at 
intervals in order that the treatment instituted in the hospital may be carried on, 
and the personal help of the physician be continued for a short time. 

The report of the department shows what a large proportion of the patients is 
juvenile. Increasing emphasis is being laid upon the study and treatment of 
children. The seeds of later mental disorders are often sown in early years and the 
first indications of somewhat dangerous tendencies may be discerned at an early 
stage and corrective influences may be brought to bear upon them. It is not 
easy to measure precisely the exact effect of work of this nature. It is difficult 
enough to determine statistically the effect on the general health of the population 
of the attention given to the teeth and tonsils and nutrition of individuals in child- 
hood. The fact that it may be difficult to estimate statistically the value of the 
work done does not modify our conviction that preventive work of very great 
value is being done in the out-patient department. 

On Research 

While one of the main functions of the hospital is the application of already 
existing knowledge to the treatment of cases of nervous and mental disorders, 
another function is the promotion of investigation into the causes and treatment 
of insanity. It has always been intended that the Boston Psychopathic Hospital 
should represent one of the growing points in the field of psychiatric research, 
and investigative activity has been consistently encouraged since its establish- 
ment. The scope of the investigative activity, however, has been sadly restricted 
by limitations of structure and of finance. Investigation tends to require an in- 
creasingly elaborate equipment and personnel with the re(iuisite space for their 
accomodation. Research into the fundatmental causes of disease as into other 
problems must follow the natural direction of investigation, which is not straight 
forward and continuous but which often follows a somewhat interrupted course 
due to the influence of chance observations, new discoveries in allied fields, attract- 
tive hypotheses. Sfientific investigation does not promise any immediate practical 
return. It often seems to be occupied with somewhat remote theoretical details. 
The practical man may look askance on the expenditure of money in this pursuit. 
It may be, however, through pursuing apparently remote lines of investigation 
that obscure points will be cleared up and very important practical gains for the 
health of the community be achieved. 

The various laboratories at the Boston Psychopathic Hospital are extremely 
cramped in their (juarters. The space which would naturally be allotted to the 



12 



P.D. 137 



pathological laboratory of the hospital is allotted to the special work of the depart- 
ment, and the hospital has no pathologist of its own to carry on continuous in- 
vestigations into the structural changes associated with those cases of mental dis- 
order which terminate fatally. The biochemical laboratory and the psychological 
laboratory are both hampered in their activity by lack of space. 

Notwithstanding these restrictions, the reports from these laboratories show 
that there has been a steady program of research into fundamental problems carried 
on during the past year. 

Investigation, however, is not confined to the laboratories. In the laboratories 
one may search out systematically the minute structural changes that go with 
mental disorders, the obscure changes in the chemical balance of the system that 
are associated with variations in mood and behaviour, the underlying evidence 
for the presence of infective processes or faulty action of the vegetative nervous 
system. It is equally necessary in the wards to broaden and deepen our knowledge 
of the actual symptoms of mental disorder, their course, their underlying personal 
sources, the relation of the disorder to the early conditioning factors in the home 
and the schoolroom, the relation of the mental disorder to the economic and social 
conditions of the patient's life. 

Investigations on the importance of personal characteristics and of environmental 
factors in the causation of a familiar type of mental disorder have been carried on 
during the past year, the research being aided by funds from the outside. This 
work continues studies made during previous years, the results of which have been 
published from time to time. 

In addition to the continuation of this special attack on certain broad problems 
of the development of mental disorders, members of the staff have concentrated 
on various more specialized researches. Thus a beginning has been made in an 
investigation on the fundamental processes associated with the ingestion of alcohol. 
The alcoholic psychoses promise to continue with us for many years and there are 
many unknown factors associated with these conditions. 

Investigative activity is not only justified by its special results, it is of the greatest 
value for maintaining that alert and open-minded attitude in face of the individual 
patient which is the best guarantee of a helpful attitude and constructive treat- 
ment. Unless there is a wholesome atmosphere of investigative activity, treat- 
ment is bound to become standardized and routine and the level of the general 
medical work is lowered. It is important, therefore, even for the satisfactory 
maintenance of the service function of the hospital that investigative activity 
should receive a generous measure of support. In view of the limitations of the 
present structure it was a great disappointment to find that the proposal, sub- 
mitted this year, to add to the structure of the building and to furnish adequate 
space for the steadily increasing laboratory activities did not receive the financial 
indorsement necessary for its execution. 

On the Hospital As A Training Centre 

The hospital serves not merely as a service station for the sick and as an investi- 
gative unit but as a centre where professional workers in this medical field get an 
opportunity of becoming familiar with special problems. The individual worker 
finds at the hospital an opportunity of becoming more familiar not only with his 
own specialized discipline but with the integration of his own special activity into 
the general functioning of the hospital. 

The hospital ofTers opportunities for training not only to physicians who may 
later be going into general practice or may be intending to specialize in the general 
field of psychiatry or in such departments as industrial psychiatry, court psychiatry, 
school psychiatry, it also offers opportunities to the psychologist whose interest 
may not be purely academic but who may be specially interested in the application 
of psychology to problems of human adaptation. 

On the wards fourteen affiliated nurses get a three months* opportunity of be- 
coming familiar with this special field of nursing and the familiarity thus gained in 
dealing with the personal problems of patients will be of the greatest value to them 
no matter in what field of nursing they will later be engaged. 

The social service department gives student social workers an opportunity for 



P.D. 137 



13 



learning the technique of the study of individual, domestic and social problems 
and for grasping the general principles involved in this branch of social work. 

In a similar way occupational therapists in training have an opportunity of 
applying their specialized training and school knowledge to the concrete problems 
presented by the patients in the hospital. 

If these students in various disciplines gain much from their time spent at the 
hospital, they at the same time make a very great contribution to the work of the 
hospital. The eager and alert interest of the students brings a fresh point of view 
to familiar problems, challenging procedures and requiring clear and systematic 
review of the situations which are presented by the patients; they thus help to 
maintain a very wholesome atmosphere of inquiry and intelligent discussion. 

On the General Administration of the Hospital 
The varied activities of the hospital as indicated in the reports from the special 
departments require to be coordinated. The hospital with its many interests and 
with the insistent demands made upon it by the large admission rate is a compli- 
cated machine for the smooth running of which the Chief Executive Officer is 
largely responsible. 

In July 1933 Dr. Samuel Smith Cottrell who for over a year had been Chief 
Executive Officer, died after a very brief period of sickness. Dr. Cottrell had 
shown an unusual degree of initiative and of imagination and had shown special 
energy in dealing with the living conditions of the employees which had been a 
source of much friction for years. His institution of a cafeteria was a great boon 
to the hospital. His colleagues felt his death in the prime of life as a tragic blow. 

It was fortunate that Dr. Arthur N. Ball, who had previously been Chief Execu- 
tive Officer at the hospital, was available to take up the executive duties at the hos- 
pital on the death of Dr. Cottrell. His familiarity with the needs of the hospital 
prevented any serious interruption in its smooth running. 

Earlier in the year, in January 1933, the Boston Psychopathic Hospital, with 
all the other state hospitals, suffered a great blow in the death of Dr. George M. 
Kline, Commissioner of Mental Diseases. Dr. Kline was a great administrator and 
there has been placed on record in many places the appreciation by various organi- 
zations of his qualities as administrator, physician, man of science. It may here 
be in place to express personal appreciation for the encouragement and support 
which Dr. Kline had given to your Medical Director during twelve years of service. 

In finishing this report it is appropriate to express appreciation for the loyal 
services which, during the past year, have been given by the professional workers 
in their various departments and by the employees of the hospital. In the pro- 
fessional work of the hospital, with its obvious limitations and restrictions and 
opportunities for friction, it is a great comfort to have had this year, as in the past, 
an atmosphere of good comradeship, willing cooperation and subordination of 
minor personal interests to the main task of doing the best for the handicapped 
patients admitted to the hospital. 

I wish to thank the Board of Trustees for their continued interest in the efficiency 
of the hospital and for the generous way in which they have given of their time 
and energy in dealing with many practical problems which have arisen. 

It is a great pleasure to express appreciation of the support which has been re- 
ceived from Dr. James V. May, the new Commissioner of Mental Diseases. Not- 
withstanding the many demands made upon the Commissioner, the special diffi- 
culties associated with the assumption of his new responsibilities in a year of 
exceptional difficulty, the duties which devolved on him as President of the America 
Psychiatric Association in a year when it held its annual meeting in Boston, Dr. 
May has been able to give sympathic consideration to all problems connected with 
the Boston Psychopathic Hospital which were presented to him. 

liespectfully submitted, 

C. Ma( FIE Campbell, 

Medical D\r, rfnr. 



P.D. 137 



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D. 137 




16 



P.D. 137 



REPORT OF THE ACTING CHIEF EXECUTIVE OFFICER 
To the Board of Trustees and the Medical Director of the Boston Psychopathic Hospital: 

In returning after an absence of nearly two years to the duties of Chief Executive 
Officer at the Boston Psychopathic Hospital I find the executive routine and 
personnel, with the exception of the ward medical staff, to have chatiged but little. 

During Dr. Cottrell's nin^eteen months as Chief Executive Officer he was able 
to bring about changes that his predecessors had advocated but had been unable 
to accomplish for over ten years. I refer to the concentration of all employees in 
one dining room convenient to the kitchen, with consequent lowering of costs and 
decided dietary improvement, not to mention improved housing, storage and 
office space resulting from four discarded dining rooms. On January 9, 1933, 
the new cafeteria was formally opened. It was developed from three rooms for- 
merly used as nurses' dining room, attendants' dining room and the serving room 
for these two. In addition a small portion of the kitchen was also taken. This 
cafeteria seats 70 people, is beautifully decorated and equipped in the most approved 
and up to date manner. Even at the noon hour when on week days an average 
of 150 are served there is no congestion and no delay, and the food is served in a 
much more palatable form than was formerly possible under the old system of 
feeding from six dining rooms. The new cafeteria is surely a monument to the 
energy, concentration and salesmanship of Dr. Cottrell. 

As noted above, the new arrangement of dining room space augmented to some 
extent the housing facilities of the hospital. It is, however, increasingly apparent 
that the activities of the Boston Psychopathic Hospital have far outgrown the 
housing facilities. A glance at the reports of admissions, out patient work, labora- 
tory and research work and other activities carried out during the year within a 
building of such small size, will show a rather astonishing concentration. It is 
very evident that far more space than is available in the present plant is needed 
for some of the departments, particularly the Therapeutic Research conducted 
by Dr. Solomon. Additional buildings seem the only specific remedy for the 
difficulty and this matter has been often discussed by your Board. If more space 
is not to be had in the near future, I would suggest the removal of one or more de- 
partments to other locations where there would be an opportunity for the expansion 
that they deserve. It is hoped that funds necessary for rearrangement of labora- 
tory space will be available during the coming year. 

Budget expenditures during the year were carried out as scheduled, with the 
exception that $1,500.00 was transferred from Personal Services to Medical and 
General Care. The latter item, while liberal as compared with the allowance given 
other State Hospitals, has never been ample to carry out desired treatment. In 
the matter of food we could have been somewhat more liberal, but I doubt that 
there would have been fewer complaints if expenditures had been doubled. There 
have been no complaints relative to food so far as I know from any patient, and it 
has been felt that employees should not at this time expect a fancy diet at public 
expense. With this thought in mind a strict economy is being practiced, but 
because of the recent great increase in the cost of most commodities it has been 
necessary to expend the entire budget allowance under many items. 

The clinical activites of the hospital are discussed in considerable detail in the 
reports of the Medical Director and the many departments, and it is with some 
measure of pride that the Executive looks upon the clinical accomplishments of 
his associates. 

I take this opportunity to thank the members of your Board for the uniform 
good will and helpfulness, and perhaps forbearance, they have always shown 
toward me. 

Respectfully submitted, 

Arthur N. Ball, M. D., 

Acting Chief Execuiioe Officer, 



P.D. 137 



17 



REPORT OF THE OUT-PATIENT DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith submit the annual report of the Out-patient Department for the 
year ending November 30, 1933. 

The staff of the clinic during the past year was as follows: 

Dr. C. Macfie Campbell, Medical Director of the Hospital. 

Dr. Oscar J. Raeder, Chief of Out-patient Department. 

Dr. Mary Palmer, Assistant Physician. 

Dr. Charles B. Sullivan, Assistant Physician. 

Miss Annie C. Porter, Clinic Manager. 

Special Workers: Dr. Ella Prescott Cahill; Dr. Henry B. Elkind; Dr. Hortensia 
A. F. Robinson; Dr. Myer Brody; Dr. Arthur McGugan; Dr. Charles H. Kimberly 
Dr. William J. Roth, Jr.; Dr. Conrad Wall; Dr. Joseph Michaels; Dr. Irma 
Bache; Dr. Gaylord P. Coon. 

During the year 1932-1933 there were 752 new patients and 266 old patients, a 
total of 1,018. Of the new patients 367 were male, 385 female. Among the 367 
male patients 198 were adults; 45 adolescents a4 to 18 years inclusive); and 124 
were children. Of the 385 female patients 214 were adults; 95 adolescents; and 
76 children. 

Visits made by 752 new patients number 1953. Old patients made 924 visits, 
a total of 2,877 visits as compared with 2,782 visits made last year by 814 new and 
24 i old patients. There was a somewhat greater number of patients who were 
more intensively treated over a longer period of time. 

The reasons for consulting the clinic were numerous. For convenience they 
have been grouped under the following headings: (a) behavior, 159 patients; (b) 
domestic, 28 patients; (c) educational, 76 patients; (di neuropathic, 347 patients; 
(e) personality, 13 patients; (f ) routine examinations, 77 patients; (g) vocational, 
7 patients; (h,' a miscellaneous group, 45 patients. 

The most frequent complaints were those with neuropathic conditions. Under 
this heading we find 83 patients complaining of pains in various parts of the body. 
These were for the most part neurasthenics. Seventeen were brought to the clinic 
because of abnormal ' mental condition", and 7 more for peculiar ideas. Various 
forms of dizziness, convulsions, spasms, seizures, spells made up the chief complaints 
of 24 patients; fears, simple and special, in 9 patients; depression in 45; nervous- 
ness and neurotic traits in over 40 patients. Speech difficulties, headache, anxiety, 
fatigue, insomnia, twitching, hallucinations, delusions, irritability, and many others 
too numerous to mention are included in this heterogeneous group. (See table,. 

The patients were referred from different sources as follows. Social agencies, 
248; other hospitals, 129; private physicians, 101; relatives and friends, 101; 
own initiative, 48; school, 38; Boston Psychopathic Hospital, 32; court, 26; 
Department of Mental Diseases, 5: various, 24. 

Among the diagnoses the psychoneuroses as usual rank first with 148 new cases, 
of which 79 were males and 69 females. There has been a further increase in the 
number of males over the females in this group. Last year 48' o were males. This 
year 54' ; are males, an increase of G' ; , the same increase as last year when the per- 
centage of male psychoneurotics rose from 42' o to 48%. Is the economic strain 
in these times of depression to be regarded as operative here? These men are prepon- 
derantly of the unemployed group and almost all worried by their inability to 
provide for themselves and their families. Frequently they are depressed also by 
the humiliation of being forced to accept public aid. 

The next largest group was the retarded and feebleminded group. There were 
66 males and 91 females. These were largely children; only 9 were men and 12 
women. Many of these were brought to the clinic for conduct disorders. Among 
the school children truancy, stealing, aberrant behavior, disobedience, running 
away from home, etc. were common complaints. In other words, emotional 
reacticns due to inability to compete with their fellows and to derive sati.sfaction 
from their work because of subnormal intelligence brought these children in for 
psychiatric attention. Not rarely children of superior intelligence have also been 
conduct problems. In these cases, usually because their extra capacities were not 
being utilized, there was excess energy above the school work requirements which 
sought for expression and resulted in misconduct. 



18 



P.D. 137 



Psychometric tests were applied on 77 other patients with average or superior 
intelligence. These cases include such conditions as sex delinquency (unmarried 
mothers), conduct disorders (spoiled child, bad home situation) in which a normal 
child has been conditioned to abnormal behavior and wrong ways of living by 
neurotic or over-protective parents, etc. (See table for relative number of male 
and female patients, adults, adolescents, and children who were given intelligence 
ratings with the aid of special psychometric tests). 

Under "normal children" of which 17 were so diagnosed, are found children 
brought up for adoption, some school and conduct problems in which bad home 
conditions or other extrinsic factors caused temporary anti-social conduct. 

There were 26 "neurotic children", 15 males and 11 females. Enuresis, temper 
tantrums, disorders of sleep, etc. have been studied here. 

Closely allied to these conditions are those included under "personality defect" 
14 patients. It is often a difficult matter to determine into which category such 
a patient should be put. 

There were numerous adults among the "deferred diagnoses" — cases of marital 
incompatibility, probably some psychoneurotics and other undifferentiated con- 
ditions. 

For other types see table of " Diagnoses." 

Under the law (Chapter 215, Acts of 1931) which requires a physical and mental 
examination of all children who are about to be committed to public institutions, 
there were 27 patients examined, 14 males and 13 females. 

The school clinic survey for backward children in the Brookline Schools was 
again conducted by Dr. Mary Palmer of the Out-patient Department, aided by 
the following staff. 

Mrs. Gertrude Pierce, teacher, 

Mrs. Ada Joyce, visiting teacher, Brookline Schools, 
Miss Viola M. Jones, psychologist. 
Mrs. Gertrude Wells, psychologst. 
Miss Beth Williams, student assistant psychologist. 
The following is the report of this year's survey. 

Names of Schools and Number of Students Referred 
Baldwin . .17 Heath . .10 Pierce . .53 

Cabot .... 1 Lawrence ... 1 Runkle . .53 

Devotion .11 Lincoln .34 Sewall . . .10 

Driscoll . .16 Longwood ... 2 

Total 208 

Boys, 147; Girls, 61. 

Examined for first time: boys, 110; girls, 47: total, 157. 
Examined for second time: boys, 37; girls, 14; total, 51. 

Classification of pupils examined for the first time on basis of Intelliqence Quotient 



I. Q. 69 or 

less 

(Feebleminded) 


I. Q. 70-79 
(Borderline) 


I. Q. 80-89 
(Dull) 


I. Q. 90-109 
(Average) 


I. Q. 110 

and over 
(Superior) 


T. M. F. 
8 4 4 


T. M. F. 

19 13 6 


T. M. F. 

27 16 11 


T. M. F. 

82 64 18 


T. M. F. 

21 13 8 


Total: 157; boys, 110; girls, 47. 

Classification of pupils re-examined in 19S2-1933 


I. Q. 69 or 
or less 
(Feebleminded) 


I. Q. 70-79 
(Borderline) 


I. Q. 80-89 
(Dull) 


I. Q. 90-109 
(Average) 


I. Q. 110 

and over 
(Superior) 


T. M. F. 
15 11 4 


T. M. F. 

11 8 3 


T. M. F. 
12 8 4 


T. M. F. 

13 10 3 


T. M. F. 



Total: 51; boys, 37; girls, 14. 



P.D. 137 



19 



Recommendation ftr Special Class 
First Examination: total, 6; boys, 6; girls, 0. 

Recommendation for Special Class — re-examination 
Total, 6; boys, 5; girls, 1. 

Retardation 

5S students were 1 year retarded: 

4 were probably feebleminded. 

1 was of borderline endowment. 
12 were of dull normal endowment. 
36 were of average endowment. 

^5 students were 2 years retarded: 

2 were probably feebleminded. 
12 were of borderline endowment. 
16 were of dull normal endowment. 
14 were of average endowment. 

1 had an intelligence quotient of 114%. 

1 ^ students were years retarded: 
2 were feebleminded. 
4 were of borderline endowment. 
2 were of dull normal endowment. 
6 were of average endowment. 



t students were L years retarded: 

1 had an intelligence quotient of 68% with a reading disability. 

1 had an intelligence quotient of 74% with a reading disability. 
Reading disabilities: 68 students. The total is especially high because a number of 
children were referred from the first and second grades. These, with few exceptions 



could obtain no credit in reading tests. 

The following table is an analysis of these 68 students: 

Grades Students Grades Students 

Special 5 Fifth 14 

First . ... 13 Sixth 5 

Second ... 16 Seventh 1 

Third 9 Eighth 1 

Fourth .4 



The eflfect of reading disability upon school achievement in bright children is 
seen in the following: 

12 children of average intelligence were 1 year retarded. 
9 children of average intelligence were 2 years retarded. 
6 children of average intelligence were 3 years retarded. 

In addition to the regular survey Miss Jones made a special study of 24 children 
in Grade I, Cabot School. 

Total examined 24; boys, 11; girls, 13. 

Number of Tests Given 53 

Stanford Binet . .13 Minnesota Pre-school 16 

Gray's oral reading paragraphs . 24 

The following statistical tables are self-explanatory and deal further with the 
work of the clinic. 

Statistics or the Out-patient Department 
October 1, 1932 to September 30, 1933 
Number of Patients 

Total patients (New patients, 752; Old patients, 266) 1,018 

New Patients: Male Female Total 

Adults 198 214 412 

Adolescents 46 95 140 

Children 124 76 200 



367 385 752 



20 



P.D. 137 



Visits 

Total visists of 1,018 patients 2,877 

(New patients, 1,953; Old patients, 924) 

Clinic days 300 

Average number of visits per day 9 

Average number of visits per day by new patients 6 

Average number of visits per day by old patients 3 

Number of patients and number of visits per year 



Old patients 


Visits 


Total 


New patients 


Visits 


Total 


117 


1 


117 


400 


1 


400 


49 


2 


98 


147 


2 


294 


33 


3 


99 


61 


3 


183 


11 


4 


44 


44 


4 


176 


11 


5 


55 


25 


5 


125 


8 


6 


48 


16 


6 


96 


9 


7 


63 


12 


7 


84 


3 


8 


24 


7 


8 


56 


1 


9 


9 


12 


9 


108 


3 


10 


30 


3 


10 


30 


4 


11 


44 


7 


11 


77 


3 


12 


36 


2 


12 


24 


4 


13 


52 


1 


13 


13 


2 


14 


28 


1 


14 


14 


1 


15 


15 


2 


15 


30 


1 


16 


16 


2 


16 


32 


1 


18 


18 


4 


17 


68 


1 


19 


19 


1 


19 


19 


1 


20 


20 


1 


23 


23 


2 


21 


42 


3 


24 


72 


1 


47 


47 


1 


29 


29 


266 




924 


752 




1,953 



Problems 

a. Behavior: misconduct, running away, sex delinquency, disobedience, lying, 
stealing, exhibitionism, and court charges; 159 cases. 

b. Domestic: abnormal home situation, establishment of home, marital difficulty, 
neglect of child; 28 cases. 

c. Educational: retardation, reading difficulty, speech difficulty, truancy, other 
school difficulty; 76 cases. 

d. Neuropathic: difficulty with jaw, "unsettled feeling", swearing, wanderlust, 
advice and guidance, fear of harming children, fatigue and lack of concentration, 
listlessness, persecutory ideas, fatigue, alcoholism, auditory hallucinations, tense- 
ness and irritability, emotional instability, confusion and irritability, delusions, 
abusiveness, obsessions, amnesia, depression, nervousness, sleep difficulty, sleep 
walking, insomnia and anorexia, grimacing, head twitching, chorea, convulsions, 
epileptic attacks, question of epilepsy, fainting spells, hysterical spells, dizziness, 
blurring and feeling of unreality, seizures, spasms, irritabilty and suspiciousness, 
lack of concentration, weak spells, question of hysteria, dizziness and headache, 
stammering, stuttering, excitability, memory lapse, compulsions, self-conscious- 
ness, inability to carry on, inferiority feeling, mental condition, self-accusation, 
peculiar ideas, overactivity, nervousness and excitability, irritability and restless- 
ness, tremors, somatic complaints, impulse to injure others, threatening self and 
family, speech difficulty, sex difficulty, irritability and nervousness, unresponsive- 
ness and crying, headache and amnesia, excitability and violence, homicidal im- 
pulse, fears, paranoid ideas, attempted suicide, suspicions, question of psychosis, 
feeling of unreality, worry, amnesia, enuresis, temper spells, mistreating children, 
nail biting and temper tantrums, eating problems, high strung child, lack of self- 
control, homosexuality, stubborn child, screaming spells, thumb sucking, anxiety, 
over-religiousness; 347 cases. 



P.D. 137 



21 



e. Personality problems: seclusiveness, peculiar personality, lack of interest, 
maladjustment, distractibility, lack of ambition, mismanagement, judgment de- 
fect, bad morals; 13 cases. 

/. Routine examinations: psychometric testing, adoption, etc.; 77 cases. 

g. Vocational problems: ability to work, re-establishment in business, vocational 
advice, ability to care for children; 7 cases. 

h. Miscellaneous: after-care, hospitalization or other institutionalization, foster 



home placement, plan for future, senility, advice on operation; 45 


cases. 




Referred by: 




Male 


Female Total 


Boston Psychopathic Hospital 




16 


16 


32 


Other hospitals 




68 


61 


129 


Private physicians 




57 


44 


10.1 


Social agencies 




70 


178 


248 


Immigration Department .... 




1 




1 


Department of Mental Diseases 




5 




5 


Court 




21 


5 


26 


Lawyer 




4 




4 


xvcj^iai/iy \ji iviutor V cuicico .... 




1 

X 




1 


Sphool 






10 


38 


i^CjJai LlllClIt v.. I'll Cl, LIU 11 .... 




o 




2 


XlClCiLlVC^ AILKX lllfZHKl^ ..... 




56 


45 


101 


Own initiativp 




27 


21 


48 


Churoh 








1 


i>i cwajjoptrr ctrLiLlc ...... 




1 n 


4 


14 








1 


1 






367 


385 


752 
Per Cent 


Diagnoses 


Male 


Female 


Total 


of Total 


Senile psychosis 


3 


3 


6 


.8 


Psychosis with cerebral arteriosclerosis . 




1 


1 


.1 


General paresis 


3 


- 


3 


.4 


Psychosis with other brain or nervous diseases — 










Tabes dorsalis 


1 


_ 


1 


.1 


Alcoholic psychosis 


6 


_ 


6 


.8 


Psychosis with other somatic diseases 


_ 


3 


3 


.4 


Manic-depressive insanity . . 


5 


11 


16 


2.2 


Involutional melancholia 


1 


2 


3 


.4 


Dementia praecox . . 


20 


10 


30 


4.0 


Paranoid 


2 


4 


6 


.8 


Psychoneurosis: 










Hysteria 


5 


4 


9 


1.0 


Psychasthenic 


19 


10 


29 


4.0 


Neurasthenic 


9 


11 


20 


2.5 


Others . .. 


46 


44 


90 


12.0 


Psychosis with mental defect 


1 


3 


4 


.5 


Undiagnosed psychosi.s 


1 


3 


4 


.6 


Diagnoses deferred 


: ; ,') 


35 


70 


9.3 


Without psychosis 


I 


7 


11 


1.4 


Fpilepsy 




16 


24 


3.1 


Alcoholism 


1 




1 


.1 


Acute alcoholism 


2 




2 


.3 


Affective di.sorder 


5 


17 


22 


3.0 


Psychopathic personality 


14 


7 


21 


2.6 


Normal child 


10 


7 


17 


2 2 


Neurotic child 


16 


11 


26 


3.4 


Behavior problem 


18 


8 


26 


3.4 


Chorea 


2 


1 


3 


.4 


Post-encephalitis 


3 


1 


4 


5 


Organic disease of central nervous system 


4 


2 


6 


.9 



22 






P.D. 137 


Congenital lues with mental defect 




1 


1 


.1 








1 


.1 


Psychopathic personality with mental defect 


1 




1 


.1 




6 


8 


14 


2.0 


Constitutional psychopathic inferiority. 


2 


4 


6 


.9 






1 


1 


.1 


Marital incompatibility and difficulty . 


1 

1 


6 


7 


1.0 




1 




1 


.1 




1 


2 


3 


.4 


Reading difficulty 


6 


1 


7 


1.0 




2 


1 


3 


.4 








1 


.1 






1 


2 


.3 


Medical problem 




1 


1 


.1 


Sciatica 


1 




1 


.1 


Convulsions — worms 


1 




1 


.1 






1 


1 


.1 


Tic 


1 




1 


.1 


Bell's mania 




1 


1 


.1 


Without psychoses (for intelligence ratings): 










Superior intelligence 










Adults 


3 


4 


7 


.9 


Adolescents 




2 


2 


.3 




rr 


1 


8 


1.0 


Average intelligence: 














9 


11 


1.4 


Adolescents 


7 


15 


22 


3.0 


Children 


13 


14 


27 


4.0 


Retarded and borderline intelligence: 










Adults 


5 


6 


11 


1.5 


Adolescents 


12 


30 


42 


6.0 


Children 


28 


27 


55 


7.3 


Feebleminded: 










Adults 




6 


10 


1 . 


Adolescents 


5 


13 


18 


2.3 




12 


9 


21 


3.0 




367 


385 


I DC 




Nationality 




Male 


Female 


Total 


African 




8 


14 


22 


Armenian 




2 


1 


3 


Dutch ........ 




1 


2 


3 


English 




36 


38 


74 


Finnish 




3 


_ 


3 


French 




7 


18 


25 


German 




2 


6 


8 


Greek 




2 


5 


7 


Hebrew 




53 


41 


94 


Irish 




61 


51 


112 


Italian 




40 


28 


68 


Lithuanian 




Q 

o 


1 


4 


Portuguese ....... 




1 


3 


4 


Scandinavian 




5 


8 


13 


Scotch 




7 


11 


18 


Slavonic ........ 




Q 
O 


9 


12 


Spanish 






1 


1 


Syrian 






3 


3 


Welsh 




1 




1 


Mixed race 




on 

89 


79 


168 


Other race 




2 


1 


3 



P.D. 137 ^ 

Race unascertained .41 65 ^06 

367 385 752 



Disposition 
Boston Psychopathic Hospital 
Out-patient Department 
State hospital recommended . 
Wrentham or Waverley recommended 
Agency report .... 
Court report .... 
General hospital 

Relatives 

Little Wanderer's Home . 
Judge Baker Foundation 
Lawyer advised 
Discharged .... 



Male 


Female 


Total 


45 


48 




187 


141 




11 


8 


1 Q 


5 


2 


<7 
- 1 


95 


170 




15 


12 


27 


2 


2 


4 


4 


1 


c 
o 


1 




1 


1 




1 




1 


1 


• 1 




1 


367 


385 


752 



As in previous years clinic stan meetings lor tne aiscussiun ui paiti^ux**. v,»o^o 
studied in the clinic were held on Monday and Wednesdays throughout the year. 
These meetings are presided over by the director and are an important factor in 
stimulating the work of the staff as well as that of the students of medicine, psy- 
chology, sociology, and nursing. Executive staff meetings were held from time to 
time for the discussion of problems of policy and administration. 

I wish to record here the wholesome spirit of cooperation of all the staff members 
of the various departments of the hospital which has often been largely responsible 
for the successful handling of the many annoying and patience-taxing problems 
peculiar to a neuropsychiatric clinic. 

Respectfully submitted, 

Oscar J. Raeder, 

Chief of Out-patient Department. 

REPORT OF THE CHIEF MEDICAL OFFICER 

To the Medical Director of the Boston Psychopathic Hospital: 
I herewith submit the medical report for the year. 

In general, it may be said that the medical service has continued with little 
change. We have been quite adequately staffed during the past year, and with 
the number of volunteer physicians working at the hospital we have been better 
off in this respect than for many years. 

Dr. Solomon has continued to use Ward A for the treatment of cases of neuro- 
syphilis. With the alterations going on at the hospital at the present time, the 
office of the Chief Executive Officer will probably be added to this ward which 
should afford him added space and allow more cases to be kept in the hospital for 
intensive study and treatment, with almost no additional expense. 

Ward B has been vacant throughout the year. With the present nursing staff 
of the hospital, it is not possible to use it and as no funds have been available from 
private sources for such a purpose the ward has been closed. There are many in- 
teresting research projects, particularly some bio-chemical studies of the blood 
which Dr. d'Elseaux could carry out if it were possible to open up Ward B. 

Another suggested change has been to revert to using Wards A and B as admission 
wards for new patients. To do this would necessitate an increase in our nursing 
staff and would throw many difficulties in the research work which is at present 
being carried out. i * *u 

The general lack of funds has been reflected to some extent in the work of the 
hospital in that certain pieces of research could not be carried out and also the 
general medical study and treatment of our ca.ses has been to some degree curtailed. 

As has been pointed out before in previous reports, the hospital has a most 
interesting group of obscure medical conditions as well as a number of such well 
recognized diseases as diabetes, pernicious anemia, etc. for which very definite and 
somewhat expensive treatmont is neces.sary. The continued decrease in funds 



24 



P.D. 137 



available for medical care has placed a great strain on the facilities for treatment. 
Unlike the other state hospitals for mental diseases, this hospital has a very high 
percentage of physically sick patients. The amount of nursing care, the amount of 
money needed for drugs and other medical treatments per patient must therefore 
be necessarily much higher than at the other state hospitals. 

The use of our x-ray during the past two months has been quite seriously handi- 
capped by lack of films. Endeavors have been made to curtail the number of 
x-rays taken and to reduce such expenditures to a minumum. It is doubtful, 
however, whether it is really economical to reduce expenditures of this sort and 
whether it does not result in increased costs in other ways. 

Considerable more work has been done in physiotherapy this year, particularly 
the use of ultra violet treatments. 

It is hoped to do some special work with colonic irrigations during the coming 
year, and equipment has been loaned for this purpose. Other hospitals have re- 
ported somewhat variable results from these treatments, and it is felt that we should 
give these methods of treatment for which some claim highly beneficial results a 
fair and impartial trial. 

Recently, Dr. T. A. Marlow has been appointed as an additional consultant in 
internal medicine and arrangements have been made whereby he makes rounds 
three mornings a week, seeing cases on which special medical opinion is desired. 
So far this has worked out most satisfactorily. The clinical staff has been stimu- 
lated to added interest in the physical condition of their patients and the thorough 
check-up of their findings which Dr. Marlow has made, together with the discussion 
of the cases has been extremely helpful. For many years I have noticed a tendency 
for the young doctor coming into psychiatry to lay aside his medical training when 
he approaches a case, and often to become so interested in the psychiatric impli- 
cations that the physical side is lost 'sight of. This frequently occurs even among 
men who have just completed a general medical interneship. I feel that Dr. 
Marlow's work will tend to prevent this from occurring. 

When the Veterans Bureau discontinued the use of the Out-patient Department 
afternoons, it was felt that an afternoon out-patient clinic might be of value. We 
already have a morning clinic functioning smoothly and efficiently with a part- 
time staff; therefore, this staff would not be available for the afternoon work. 
Accordingly an attempt was made to secure voluntary workers for the afternoon 
clinic, and with this in mind an endeavor was made to concentrate on the intensive 
treatment of children. Most of the doctors working in the afternoon clinic have 
been research fellows from the Department of Psychiatry of the Harvard Medical 
School. During the year nine doctors have worked in the afternoon clinic and 140 
cases have been treated. It is not easy to build up such a clinic on a purely voluntary 
basis but it is felt that there is need for increased use of our out-patient facilities 
and that an afternoon Out-patient Clinic is desirable. Endeavor will be made to 
continue this clinic during the coming year. 

The number of cases sent into the hospital by the courts has continued to increase 
steadily. There were 214 cases sent in under Section 100 who spent a total of 
2,865 days in the hospital. The approximate cost of caring for these patients would 
be $21,500. In addition to this, there were about 60 more cases which were sent 
in under other provisions of the law, but in which some report was made to the 
courts. It will thus be seen that the work done for the courts forms a very definite 
and important part of the work of this hospital and that these patients represent 
a considerable item in the expense of running the hospital. 

The report of the dentist follows: Patients examined, 1,759; patients treated, 
920; extractions, 966; fillings, 451; prophylaxis, 217. 

Dental radiographs showed 39% of those examined to have infected teeth, and 
11% were found to have impacted teeth. 

There has been an increase in patients showing pathology of the gum margin. 
More than the usual number of cases of pyorrhea, gingivitis, and Vincent's infection 
were observed. 

The X-ray report for the year is given below. Number of patients. 
Month M. F. T. Month M. F. T. 

December ... 37 22 59 June .... 30 12 42 



P.D. 137 



25 



January 


. 63 


10 


73 


July 


. 27 


4 


31 


February 


. 26 


15 


41 


August 


. 28 


18 


46 


March 


. 37 


30 


67 


September 


. 33 


15 


48 


April 


. 30 


8 


38 


October 


. 17 


22 


39 


May 


. 38 


16 


54 


November . 


. 27 


12 


39 



Male, 393; female, 184; total 577. The total number of examinations made was 
861. 



Physiotherapy Department 

Number of treatments, 1,756; Ultra-violet light — air cooled and water cooled, 
1,540; infra-red with massage, 78; diathermy, 120; fulguration, 4; auto-conden- 
sation, 4; sun baths, 10. 

Xumber of patients, 68: Out-patients, male, 7; female, 8. In hospital, male, 28 
female, 25. 

Respectfully submitted, 

Karl M. Bowman, 

Chief Medical Officer. 

REPORT OF THE BIOCHEMICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

The survey of the work of the laboratory, recorded in my annual report last 
year was incomplete, We have, therefore, in the current year kept a more accurate 
account of the various types of examinations which have been performed in the 
laboratory. An attempt has been made to correlate the monthly variation of the 
work with the admission rate and medical consultation rate. While there is fairly 
close general correlation between the last two, it will be seen (Table I) that there 
is no correlation between the admission rate and the laboratory work. The figures 
given refer only to the routine study of patients and do not include any of the 
research activities and, consequently, greater concordance would be expected. 

Table I. 

Shows Seasonal Variation of Laboratory Work of the Hospital 











Formal 






Hoapital 


Hospital 


Clinical 


Medical 


Chemical 






Admissions 


Laboratory 


Consultations 


Laboratory 


December . 




162 


638 


11 


248 


January 




178 


646 


4 


244 


February 




163 


520 


5 


308 


March 




184 


544 


12 


244 


April . 




168 


618 


8 


202 


May 




177 


584 


9 


255 


June 




162 


600 


2 


231 


July . 




162 


559 


2 


233 


August 




192 


558 


5 


255 


September . 




157 


611 


15 


264 


October 




186 


665 


8 


288 


November . 




171 


612 


3 


256 



Monthly Averagj^ 172 595 7-8 242 

Tabl'-, II 

Exhibiting Annual Work of Clinical and Chemical Laboratories 

Individual 

Typ* of Examination Ittms Aggrsgoit 

Blood examinations 4,300 

Hematological (including cell counta) 3,462 
Bleeding and clotting time . 2 

Icterus index . 9 

Chemistry . 837 

Non protein nitrogen ititi 
Blood sugar . . :iM 
Cholesterol 5 
Blood chlorides . 6 
Calcium (serum) 6 
Serum bromides 33 



26 



P.D. 137 



Serum potassium 3 

Uric acid 13 

Serum phosphorus 5 

Creatinine 6 

Miscellaneous 15 

Urine examinations 3,204 

Routine 3,159 

Phenolsulphonephthalein test 40 

Mosenthal tests 5 

Gastro-intestinal studies 27 

Stool examinations 11 

Gastric analyses 12 

Examination of vomitus 4 

Smears examined 69 

For gonococci 45 

Sputum for Tuberculosis 20 

For Vincent's organisms 4 

Basal metabolism determinations 136 136 

Spinal fluid examinations: 

Complete examinations 1,477 

From house cases 681 

From outside sources 289 

Treatment cases 263 

Specimens from outside sources for gold sol only . . . 244 

Chemical examinations 2,064 

Total protein 1,233 

Sugar 819 

Chloride 12 



A study of the types of laboratory examinations performed indicates the essential 
physical normality of our hospital population. The urine and blood examinations 
are, of course, routine and the spinal fluid examination nearly so. Of all the ex- 
aminations made only a small proportion are definitely indicative of the search for 
visceral disease or deranged somatic function. 

We were rather surprised at the total number of analyses when we consider that 
these figures do not include the pathological work, the Wassermann work, the 
research activities nor the bacteriology. Furthermore, the actual number of tests 
is larger than indicated because we have grouped all hematological examinations 
together although, in a large proportion of these, more than a single count was 
done. Similarly, we have not separated the four items constituting our examina- 
tion of the spinal fluid. 

A very important start in the direction in which I think the laboratory should 
develop, as mentioned in my last report, has been made in the study of alcoholic 
patients by Dr. Fleming and Mr. Stotz. Mr. Stotz is a trained chemist working 
for his doctorate in biochemistry under Professor Folin at the Harvard Medical 
School. He comes to us on a half-time basis and has developed a satisfactory method 
for the determination of small amounts of alcohol in blood and spinal fluid and a 
micro method, of somewhat less accuracy, for the determination of alcohol in 
minimal amounts of blood. These methods are to be published separately from 
the extensive and valuable work that he and Dr. Fleming are doing on the fate of 
ingested alcohol in a variety of patients. Both the blood and spinal fluid are being 
studied and valuable results are already apparent. Dr. Fleming has organized the 
work on a very satisfactory basis and his enthusiasm and energy, combined with 
that of Mr. Stotz, is producing rapid results. 

It is my belief that this type of work should be stimulated more than has hitherto 
been the case. It must again be emphasized that the problems must originate with 
the clinical staff. Provided one of the many projected rearrangements of labora- 
tory space is carried to fruition, the laboratory will be able to cooperate in a 
number of such combined researches at a minimal increase in expense. I believe 
that a wide field is open, if the clinical staflf can be interested in problems which, 
in the last analysis, form an ideal approach to the study of the patient. It is essen- 
tial that the senior members of the staflf should guide their juniors into a more 



P.D. 137 



27 



definite quantitative formulation of psychiatric problems in physiological terms. 
I have suggested at various times that a study of the hypnotics would be an ex- 
tremely valuable addition to our knowledge of the drugs and at the risk of repetition, 
I should again like to say that such a study as to the detailed effect of hypnotics 
on patients might provide an ingress into the psyche of their patients which is not 
ordinarily available. A similar study in relation to the antipyretics (analgesics) 
is entirely feasible and the ground work for this has been already laid by the experi- 
mental work of Barbour and others. However, it is necessary if the linkage of 
psychiatric entities with physiological mechanisms is to be accomplished and if 
the young psychiatrists who come to us are to be trained in the sense that the fn- 
ternist is trained, that there must be a very vigorous attempt on the part of the 
clinical staff to formulate their problems of mental disease in such a way that they 
may be quantitatively linked with psychiological mechanisms. 

I have repeatedly pointed out to various members of the staff that our practice 
in regard to sedative drugs is not abreast of the most recent pharmacological data 
and I am very anxious to see this problem attacked not only from the point of 
view of the psychiatrist but from the point of view of pharmacodynamic elucidation 
of the action of these drugs. 

It is a pleasure to mention the activity of Dr. d'Elseaux and his assistants and 
to add my commendation of their work to that of all who have followed it. This 
will be more fully reported elsewhere. 

If the projected plan of studies, such as those that Dr. Fleming is making, is to 
be broadened in its scope, adequate space for individual workers must be provided 
for in the projected plans for the enlargement or removal of the laboratory. With 
such space available, our laboratory can probably suggest and participate in the 
technical working out of physiological problems though it should be emphasized 
that this bilateral attack on a problem will be unnecessary when our clinical psy- 
chiatrists come to us trained in the physiological sciences as are so many men enter 
ing the other medical specialties today. 

The staff of the laboratory for the past year has been as follows: Junior chemist — 
Mildred G. Gray; Special assistant — Elmer H. Stotz; Laboratory internes — 
Thomas R. Ingham, Robert J. Kinney, Donald T. Hall, H. Stanley Bennett. 

Respectfully submitted, 

G. Philip Grabfield, M. D. 

Chief Biochemist. 

REPORT OF THE PSYCHOLOGY LABORATORY 
To the Medical Director of the Ronton Psychopathic Hospital: 

In view of the recognized inadequacy of the laboratory quarters it may be relevant 
for future developments to mention particularly certain requirements for efficient 
functioning. An organization devoted to this class of work requires especially 
separate rooms which may be small, but must be independently accessible. 
Deficiency in this respect has always been a drawback in the present layout but 
one apparently unescapable so long as the quarters remain in their present 
location. 

In the present set of rooms the most immediate single need is space suitable to 
the use of persons training or carrying on research in psycho metrics, for both 
teaching and study purposes. If changes now in prospect can be carried out, floor 
space will be fairly adequate to both clinical and teaching demands save for the 
limitations of arrangement above noted. Among other special needs which it is 
hoped to meet are suitable oflice space for the laboratory secretary, and a room of 
adequate size (as lioom 423) which can be arranged essentially for class-teaching 
purposes. 

The Medical School teaching has been altered in that the material formerly given 
to sections can now be presented in illustrated lectures during the first year and 
the section work of the third year devoted to demonstrations, to which it is more 
suited. 

In the previous report some attention was paid to teaching problems raised by 
the afl^liate nurses, and it is proposed to make these the principal theme of the 
present report. There is issued by the National League of Nursing Education as 
part of a standardized curriculum, the outline of a course in ''psychology*' of 



28 



P.D. 137 



thirty hours. (The class-room time here available is about half this amount). 
Aside from some minor questions of relevance in content (it is tied too closely to 
the academic model) this outline is skilfully prepared, and evinces entire familiarity 
with the scientific topic itself. Objectives are admirably stated, and it fairly 
represents a goal to aim for; but it is considerably idealized with reference to the 
teaching and learning situations that enter into the present purview. It can 
scarcely be a normal expectation to secure a competent teacher of such a course 
in the manner suggested. For students to assimilate this content under the avail- 
able conditions of study, requires a degree of learning capacity to be looked for 
only in very exceptional nursing schools. The intellectual background is normally 
below that which can be assumed among college students, to whom, mutatis 
mutandis, the above outline would be fairly suited. It is true that under present 
general conditions, select hospitals (outside exceptional cases making a require- 
ment of college training) have entering classes that compare in intellectual level 
not unfavorably with college students (an alpha score of 196 was recently observed 
in extramural service, and scores of 170 are not a rarity). In the present affiliate 
groups which may be taken as more representative, the average range is between 
120 and 130 alpha, and scores below 100 are occasionally seen. To acquire meaning 
under such conditions, the topic must be presented much more simply and con- 
cretely, and more closely integrated with actual life situations of the students, and 
not as nurses only, but as adjusting personalities. There are available several 
texts in psychology intended for nurses' use, and among them there is fair effort 
to present the topic in terms of nursing experience. But the topics themselves con- 
tinue organized too much on the scholastic model. To be quite satisfactory, a text 
must be oriented towards the personality as an adaptive unit, as well as freely 
utilizing the symbols of nursing experience. It is only by fortunate chance that the 
ability to produce such a work will be found in a single individual. The text pre- 
pared by the pre'sent writer, alluded to in the previous report, seems to function 
satisfactorily from the standpoint of adaptive orientation within the limits of its 
subject matter, but embodies little of the symbolism of nursing experience. From 
the point of view of collateral study it is planned to supplement this material with 
a content of simpler level (Winsor's Art of Behaviour). For general teaching pur- 
poses texts of "reassurance" psychology such as typically produced by W. B. 
Pitkin, should be particularly useful. 

So much for content that can be studied from the printed word. Classroom 
sessions should not parallel or duplicate such material, but elucidate and support it. 
The place of the conventional "lecture" in this function is very limited indeed. 
Much more information than is likely to be gained in such a way can be trans- 
mitted through reference to special circulars, or carefully selected reading. Neither 
is the intellectual maturity of these students generally suited to the lecture method 
at its best. A not too formal recitative and discussion procedure is the most 
effective, at least with groups of the size here concerned. This may be organized 
in various ways. The writer has obtained good results through requiring students 
to put in writing, questions which they based on specially assigned reading; the 
instructor then discusses these questions with the class. After a series of such ques- 
tions is accumulated it may be presented to a succeeding group of students for 
checking such questions as they wish discussed. Such procedures split the teaching 
process into brief units, as is advantageous at the intellectual levels concerned. 
There is also available to the laboratory, a series of lantern slides dramatizing 
vaiious psychological points, selected for this purpose from the illustrated press. 
This material may be presented and discussed in the form of an "illustrated" 
lecture; but the better procedure is to display the slides and call for their discussion 
by the class, which has previously studied textual references bearing upon them. 

In examinations, the students are apt to prefer a "true-false" test because it 
saves them the trouble of verbalizing, in which they often feel deficient. But the 
uniform result has been that much better grasp is displayed in examinations of the 
"essay" type. The reason for this is that true-false items in this field are difficult 
to frame so as to be "hole-proof" from the standpoint of the examiner and at the 
same time intelligible to students at this level. When it is desired to use true- 
false procedure, the items should always be in the form of direct questions, to be 



P.D. 137 



29 



answered by indicating a printed "yes" or "no". The use of plus or minus signs, 
and the underlining of "true" or "false", are too complicated. 

With regard to clinical and research concerns: The problem of reading difficulties 
among school children has been given increased attention. A number of cases have 
been followed in remedial training, which has led to the development of various 
special devices for teaching and testing. The cases seen have been mainly from ten 
to fourteen years old; the reading difficulties seen appear mostly functions of 
"under-analysis"; strephosymbolic difficulties form a group relatively small and 
distinct. It is expected to discuss this topic more fully in the next report. 

A week was spent by the writer as a special lecturer to the Seminar in Cultur-e 
and Personality conducted through the auspices of the Social Science Research 
Council, at Yale University, under the direction of Professor Sapir. Seminar 
meetings and a number of personal conferences were held with this group, consisting 
of thirteen Fellows representing various I^.uropean and Oriental cultures. This 
material formed the basis of a later address before the Psychological Colloquium 
at Brown University. At the instance of Professor Murchison of Clark University, 
the writer has undertaken for a forthcoming Handbook of Social Psycholoqy, a 
chapter dealing with the psychopathological concept of regression in its social and 
individual aspects. This is substantially complete. 

Dr. S. J. Beck, whose work with the Rorschach test has been the most conspicuous 
research undertaking of the laboratory during recent years, was awarded a Rocke- 
feller fellowship to continue this work and has sailed for a year's study in Europe 
thereunder. He is to return for a subsequent year at this laboratory and is pre- 
paring considerable material for publication. 

A brief account of Mr. Atwell's work on the Short Alpha test has been published, 
and the test itself, like its longer congener, is being made available through the 
Psychological Corporation. In addition to the conditioned reflex project mentioned 
in the last report, Mr. Goldman has been of assistance to the Beth Israel Hospital 
in studying the question of mental changes under thyroidectomy in certain cardiac 
cases. Mr. Goldman also prepared a very useful manual of procedure for examina- 
tion reports. Miss Jones continues her specialization in the preschool child, which 
has been greatly helped by the setting up of the attractive "Children's Room" at 
the northwest corner of the Out-patient Department. Mr. Hylan, student interne, 
has also given part time to the laboratory with special reference to evaluating the 
material gathered a few years since, with reference to learning and transfer in mental 
functions. 

Lack of space and other facilities have compelled the turning away of many de- 
sirable offers of volunteer assistance in simpler phases of the laboratory's activity. 
The laboratory has, however, been fortunate in well-qualified help of a technical 
character given by Miss Frances Dees-Porch, Miss F'lizabeth Verveer and Miss 
Beth Williams. 

Various routine services to other institutions, mentioned in previous reports, 
have been continued. 

With the more insighted treatment of psychometric data, greater stress is laid 
on the configuration, or "profile" of different psychometric functions. Attention 
was called some years since to the relative preservation of verbal functions in the 
psychoses, and other workers, especially Babcock, have utilized this function as 
a point of reference from which to estimate psychotic losses. One of the graduate 
students of the laboratory is following up this lead with special reference to a re- 
finement of technique. 

The only staff change of the year was an exchange of positions between Mr. 
Atwell and Mr. Goldman, in accordance with previous understandings and wholly 
without prejudice. 

PrBLICATCONS 

Wells, F. L. "Learning Functions in an Obscure Amnesia, with Implications 
for Re-education." Journal of General Pnychology, 19:i:J, 8, 173 197. 

Atwell, C. R. and Wells, F. L. " Army Alpha Revised Short Form." Per- 
sonnet Journal, 1933, 12, October, pp. 160 163. 

Beck, S. J. " Configurational Tendencies in Rorschach Rospon.sea. " American 
Journal of Psychology, 1933, vol. 45, pp. 433-443. 



30 



P.D. 137 



Bec^, S. J. "The Rorschach Method and the Organization of Personality." 
American Journal of Orthopsychiatry, 1933, vol. 3, pp. 361-375. 

Signed Reviews 

Wells, F. L. Mental Hygiene, 12 titles; American Journal of Orthopsychiatry, 

4 titles; American Journal of Psychiatry, 1 title. 
ArwELL, C. li. Mental Hygiene, 1 title; American Journal of Orthopsychiatry, 1 

title. 

Jones, V. M. Mental Hygiene, 1 title. 

Respectfully submitted, 

F. L. Wells, 

Head Psychologist. 

REPORT OF THE NEUROPATHOLOGICAL LABORATORY 
To the Medical Director of the Boston Psychopathic Hospital: 

During the year ending November 30, 1933 the assistant pathologist to the De- 
partment of Mental Diseases has continued as pathologist to the hospital, the 
major protion of the time being taken up with the work of the Department. 

In the past year 28 deaths occurred in the Boston Psychopathic Hospital: 19 
of these came to autopsy within the hospital and two were released to the medical 
examiner. This brings the autopsy rate to 75 per cent. Those done by the medical 
examiner showed death to. have been caused in one by fracture of the spine and 
pelvis with internal injuries. This was the result of a suicidal attempt in which 
the patient had jumped from a third story window before admission. In the other 
case released to the medical examiner death was'caused by exhaustion associated 
with delirium tremens and other possible effects of alcohol. 

Of the 19 performed by the pathologist or substitute, 11 were males and eight 
females. Fifteen were over 40 years of age. In 13 an acute infection was present 
A subdural hemorrhage was found in one case who died of lobar pneumonia. In 
another case dying with bronchopneumonia a focal unilateral meningoecnephalitis 
was demonstrated. A typical case of subacute combined degeneration of the cord 
and another with slight changes in the posterior and lateral tracts were found. This 
latter case showed clinically symptoms suggesting amyotrophic lateral sclerosis. 

Dr. Blanche Brine Daly is working in collaboration with Dr. Merrill Moore and 
the pathologist on a research problem associated with intracranial hemorrhage. 

Mr. A. E. Neilsen, the interne in bacteriology, reports the following work done 
for the hospital during the past year: blood cultures, 17; urine cultures, 4; stool 
cultures, 2; miscellaneous cultures, 37; smears, 42; dark field examinations, 2. 
He also assisted at autopsies and in the preparation of tissues for microscopical 
examination. 

Respectfully submitted, 
Anna M. Allen, 
Assistant Pathologist to Department of Mental Diseases. 

DEPARTMENT OF THERAPEUTIC RESEARCH 
To the Medical Director of the Boston Psychopathic Hospital: 

The treatment of syphilis of the central nervous system was started at the 
Boston Psychopathic Hospital in the year 1913. With the passage of a full 20 years, 
it seems pertinent to recapitulate briefly the story of the progress of treatment 
during these two decades. 

The stimulation of treatment came from the work of Swift and Ellis in 1912, 
introducing the intraspinal treatment of neuropsyhilis with salvarsanized serum. 
It may be recalled that the introduction of "salvarsan" led to great hope as to 
the possibility of a cure for central nervous system syphilis. By 1912 it had become 
evident that "salvarsan" was not especially eflficacious in general paresis, and 
only valuable in a limited number of cases of tabes dorsalis. Because of the dis- 
appointment over the effect of the drug in the treatment of these important neuro- 
syphilitic conditions. Swift and Ellis developed their technique of injecting the 
blood serum of patients who had received arsphenamin intravenously within a 
half-hour into the spinal subarachnoid space. Their clinical work consisted to a 
very large extent in the treatment of cases of tabes dorsalis. It seemed advisable 
to test the usefulness of the new technique in the treatment of general paresis, and 



P.D. 137 



31 



therefore, Dr. Myerson, Assistant Physician at the hospital at that time, was given 
the opportunity of investigating the method. A limited number of cases were 
treated with what seemed to be a modicum of success. Dr. Myerson then left the 
service at the Psychopathic Hospital, and this treatment lapsed for some months, 
until the problem of the treatment of syphilitic nervous system disorders was 
taken up in 1914 by the writer of this section, afhd has been under his supervision 
since that time. 

Continued use was made of the Swift-Ellis method, with some modifications 
such as the addition of arsphenamin to the serum, and the utilization of Byrnes' 
mercuralized serum, as well as the intravenous injection of very large doses of 
arsphenamin repeated at relatively short intervals. 

In the course of two or three years it was found that while this method had success 
in the treatment of cases of meningo-vascular neurosyphilis and tabes dorsalis, the 
effect on general paresis was not what one would desire. Good results from the 
clinical standpoint were obtained in only 10% of the cases, with serological improve- 
ment of a marked degree in a smaller percentage. While this was a very unsatis- 
factory result, it at least was encouraging in that it was much better than any 
previous attempts at treatment in general use. 

One reason for the failure of intraspinal treatment in cases of paresis was that 
the serum did not reach the portion of the brain involved by the paretic disorder. 
This statement is based in large part on the experimental work done at the hospital 
in a study of the circulation of the cerebrospinal fluid. In retrospect, one can see 
that some of the good results obtained may well have been the result of the febrile 
reaction produced in the patient by the treatment. To some extent this likewise 
may explain the good results obtained in the intensive treatment with arsphenamin. 
In the period under consideration, arsphenamin was not as free from impurities 
as at the present time, and severe febrile reactions were by no means uncommon. 
However that may be, in order to improve the results, the introduction of arsphe- 
naminzised serum into the ventricles and the cerebral subarachnoid space was 
utilized as an additional method. This unquestionably was an advance in so far 
as results, both clinical and serological, were concerned. 

Another method that had some vogue during the period under consideration was 
spinal drainage. According to this technique, an intravenous injection of arsphe- 
namin was given, then the spinal fluid drained out with the intent of inducing more 
of the drug to get into the nervous system. 

In 1919 the Ayer method of cistern injection came into use. In the period 
following the war, when the work was taken up with renewed enthusiasm, the 
methods of treating general paresis at the Boston Psychopathic Hospital were: 
the introduction of serum into the lateral ventricles of the brain; into the basal 
cistern; into the spinal subarachnoid space; spinal drainage; and large amounts 
of arsphenamin intravenously. A number of cases were treated by these routes, 
the type of injections alternated and given at frequent intervals, usually twice a 
week. While the results were unquestionably better than those obtained either 
by the simple intravenous injection of the drug, or by the addition of intraspinal 
injections, the rate of improvement only reached 20 of the cases. The serological 
results were certainly better than in previous methods of treatment. 

There were, however, serious draw-backs to this combination of treatment 
methods such as a certain amount of danger as well as incapacitation, and pain 
and discomfort to the patient during treatment periods; a complicated technique; 
and the time consumption of the staff. Hence, in 1923 there was readiness to try 
the effect of tryparsamide, at that time a new arsenical preparation originated at 
the Rockefeller Institute, and already favorably reported upon by Lorenz and 
his co-workers in Wisconsin. This drug, which is given intravenously, proved to 
be markedly superior to the methods already mentioned, the response in cases of 
meningo-vascular neurosyphilis being excellent, the effect on most cases of tabes 
being also highly satisfactory, and thoroughly good remissions being obtained in 
more than 30 of the cases of general paresis. The time necessary to give a treat- 
ment is very short indeed, and the discomfort to the patient practically nil. The 
use of tryparsamide, supplemented by arsphenamin, bismuth, and mercury, has 
almost entirely replaced the other treatment methods. 



32 



P.D. 137 



For many years, beginning in 1889 and continuing through this period, Wagner 
Von Jauregg, his assistants and some of his students, had been advocating the use 
of induced fevers in combatting central nervous system syphilis. During the years 
1915, 1916, and 1917, rather abortive attempts to produce fevers in the patients, 
at the Boston Psychopathic Hospital had been made with the use of sodium nu- 
cleiriate and milk protein. Sufficiently high fevers were not obtained, and the 
results were negligible and hence this was discontinued. In 1917 and 1918 Von 
Jauregg reported upon the results of inoculation malaria as a therapeutic method. 
This method, having proved relatively successful in many clinics, was introduced at 
oUr clinic in 1925 and has been used continuously since that time with results that 
are very similar to those obtained with tryparsamide. The combination of malaria 
arid tryparsamide, in some cases, gives better results than either of these methods 
used independently. 

In the search for a more satisfactory substitute for malaria, this clinic introduced 
the use of sodoku, or rat-bite fever. The results, while quite satisfactory, are 
certainly no better than malaria, and as this method involved greater difficulties 
than malaria, it has been discontinued. 

When it became evident that fever was of value in the treatment of central 
nervous system syphilis, search for a satisfactory means of producing fever had 
been undertaken in various parts of the world. Our introduction of sodoku is one 
illustration. The use of various vaccines given intravenously had been tried by 
Von Jauregg prior to the use of malaria, and at our clinic typhoid vaccine is used 
from time to time. It has also been found that diathermy and radio-thermy are 
practical methods of producing fevers, the height of which can be definitely con- 
trolled. Since 1931 the diathermy method has also been used at our clinic, and 
during 1933 we introduced the use of the electric blanket, which is simply an en-i 
larged edition of the electric pad in common household use. 

In summary, therefore, it may be said that the treatments in use at our clinic 
at the present time include; first, drug treatment, where the main reliance is put 
oin tryparsamide, but with the use also of arsphenamin, bismuth, and mercury; 
second, febrile treatment, useing for this purpose malaria, typhoid vaccine, dai- 
th'ermy, and the electric blanket. 

Early in the course of this work, interest attached itself to the mates and children 
of the syphilitic patients, and careful painstaking examinations of these close con- 
tacts of our patients has been made. In order to be able to do this successfully,: 
and also in order to be able to keep in close touch with treatment patients, and see 
that they continue treatment for a long period, social service developed in this 
department and has been invaluable. 

With the long uninterrupted period of treatment of patients, and with quite, 
careful records, a great mass of material has been obtained. Due to the efficient 
social service, many patients have been under care and observation over a number 
of years, affording an opportunity for the study of the life history of neurosyphilitic 
diseases. 

Naturally, numerous publications by several people have emanated from the 
clinic. Two books have been published dealing with the general subject and 
particularly the work of the clinic; namely, "Neurosyphilis" by Southard and 
Solomon, published in 1917, and "Syphilis of the Innocent" by Solomon and 
Solomon, published in 1922. At the present time another volume is in preparation 
based in part upon the work in the clinic, and in part on the general experience in 
Boston. 

The following table summarizes the work of the clinic during the year. 



House 

Number of new patients treated 40 

Number old patients admitted for treatment .... 27 

Out-patient 

Number new patients treated 39 

Number old patients treated 2,35 

Total treatment cases 341 

New cases of syphilis (neural and non-neural) in house but not treated 

at hospital 136 



P.D. 137 



33 



Cases remaining from previous year (neural and non-neural) but not 



treated at hospital 15 

Former house patients returning to neurosyphilis clinic for further 

diagnostic procedures 11 

Mates, children, and siblings of syphlitic patients examined in neuro- 
syphilis clinic 125 

Total clinic register 628 

Total visits to neurosyphilis out-patient department .... 4,862 
By 39 new patients for treatment) — 

By 235 old patients for treatment) 4,664 

By 122 new patients* for examination) 

By 3 old patients* for examination) 198 

Total treatments (exclusive of fever therapy) 4,909 

Given to house patients 20*6 

Given to out-patients 4,703 

Number of treatments given 341 patients (exclusive of fever) 4,909 
Acetarsone . 90 Neoarsphenamin . 209 

Arsphenamin 632 Tryparsamide 3,140 

Bismuth 813 Intraspinal ... 25 

Fever therapy 297 

Diathermy: 235 treatments given 15 new and 2 old patients. 
Malaria: 32 patients, 25 of whom were new and 7 old patients. 
Typhoid vaccine injections, 30. 

Diagnostic and therapeutic lumbar punctures 1,042 

Encephalographies 16 



Without going into details concerning the social service work with neurosyphilitic 
patients and their families in the clinic and in the field, the following brief table 
will give some idea of the extent of the activities, making the work possible. 

Number of interviews at hospital (minus clinic interviews), 281. 

Number of visits, 252: Visits to wards, 62; visits outside, 190. 

Number of telephone conferences, 1,260: Incoming calls, 436; outgoing calls, 
824. 

Number of letters written, 1,116. 

During the year study has continued as to the comparative value of diathermy 
and malaria, and during the latter part of the year, of fever produced by the electric 
blanket. At the same time, endeavor has been made to try to find the optimum 
method for the individual patient, with the use of a combination of treatment 
methods. Studies of the metabolism of patients undergoing treatment begun in 
previous years has been continued to completion. 

It is known that malaria has the effect of stimulating the reticulo-endothelial 
system with the production of various types of histiocytes. Studies are now being 
made at the hospital on the effect of diathermy on this system, for comparison 
with the effects produced by malaria. 

The staff in this part of the department has remained intact and consists of Dr. 
S. H. Epstein and Dr. I. Kopp on the medical side, and Mrs. M. H. Solomon and 
Miss Ruth Epstein in the social service. 

As reported in previous years, a research laboratory has been developed under 
the direction of Dr. Frank C. d'Elseaux. This laboratory has now become fairly 
well established for the purpose of studying the physiological aspects of patients 
with mental disorder. Among the pieces of work undertaken, the following may be 
briefly mentioned. 

1. The bio-chemical and physiological effects of diathermy as used in the treat- 
ment of neurosyphilis. This work is being prepared for publication at the present 
time and is believed to contain some highly suggestive leads as to the effect of 
various factors in the treatment of neurosyphilis and the rationale of this type of 
treatment. This work is being prosecuted further. 

2. Additional data have been obtained concerning the acidity of psychotic 
patients and the relationship of acidity to certain aspects of psychotic manifesta- 
tions. 

3. Studies of the metabolism of lactic acid are still being made. 

•These are mates, children and siblings of syphilitic patients. 



34 



P.D. 137 



4. Work has continued in the study of the physiology of acid-base balance, | 
respiration, cardio-vascular activity, and oxygen transport, especially in regard to I 
the intracranial tissues. I 
Dr. d'Elseaux has had as assistants. Miss Mary Peterman and Miss Elsa Marsh, i 
the latter being replaced by Miss Charlotte Rosen. 

As in previous years, we wish to acknowledge the whole-hearted cooperation of i 
the members of the hospital staff. This cooperation has not only made the work 
possible, but also pleasurable. 

As in the past, financial assistance has come from several sources, to wit, the Di- 
vision of Mental Hygiene of the Department of Mental Diseases, and the Depart- 
ment of Psychiatry, Harvard Medical School. 

Respectfully submitted 

Harry C. Solomon, 
Chief, Dept. Therapeutic Research. 

REPORT OF THE SOCIAL SERVICE DEPARTMENT ' 

To the Medical Director of the Boston Psychopathic Hospital: 

During the past year there has been only one change in staff. At the end of 
August, 1933, Miss Doris Stolzberg left to be married. Her place was filled im- 
mediately by Miss M. Carmen Burr, who is well-fitted for the position, having been 
associated for a number of years with the Division for the Examination of Prisoners 
under the auspices of the Department of Mental Diseases. She spends practically 
all of her time investigating cases sent here from the courts. 

In addition to the regular staff, there was one student from the Smith School of | 
Social Work, Miss Ester Jacobs, who was here for nine months in fulfillment of i 
her field work for the Degree of Master of Science. 

The amount of work carried on by the department was greatly increased by the 
aid of several volunteers. In a specialized field which deals with the subtle problems 
of personality difficulties and the adjustments of these to normal and abnormal 
environments, it is hard to use untrained people, as are most volunteers. Wc were 
particularly fortunate in having workers of experience who while waiting for paid 
positions decided to increase their knowledge of psychiatric social work. Mrs. 
Anna Paine of Boston University, Miss Elizabeth Badger of the New York School 
of Social Work and Miss Dorothy Dixon of Syracuse University were with us for 
periods varying from six weeks to several months. Miss Bernice Henderson, 
formerly clinic manager in the out-patient Department of this hospital, gave us 
six weeks of her services while on vacation from her regular position. 

The total number of cases handled was slightly higher than last year. Again 
comment has to be made on the court cases. A larger number than usual presented 
difficult problems in the matter of diagnosis. Patients who had behaved in a very 
unusual manner in the community, who had been labelled by neighbors as "crazy" 
frequently acted in a normal fashion while in the hospital or else gave a reasonable, 
if not a well judged, excuse for their behavior. Extensions of time beyond the ten 
day period allotted by the court were needed often to make the necessary inves- j 
tigation or to permit of a longer period of observation by the hospital staff. Out of 
214 cases sent directly from the courts 30 remained over 10 days each. Ten of 
these stayed 30 days and over. The average length of stay was 13 days. When it 
is recalled that the majority of the patients remained in the hospital only 6 days 
it is clearly seen that this part of the hospital work is important. Despite the long 
periods of observation only one-third of the cases were found to be committable, 
the same proportion as last year. 

As it is impossible for the small social service department to supervise all of the 
cases coming to the hospital, the problem of whom to select and how much time 
to give to each is always an acute one. Shall we allot a certain period to each one 
and then close the case, whether or not the patient desires or needs assistance so ' 
that we may take on new work? Shall we choose the borderline cases which are : 
discharged from the hospital as not psychotic? Shall we concentrate on children? 
Shall we visit the psychotic patients who have been sent home against advice? ' 
Shall we omit the cases of the feebleminded, etc.? The following cases illustrate 
some of the difficulties occasioned when an attempt is made to close after a certain '| 



P.D. 137 



35 



period, to treat on a superficial level and to neglect the other members of the 
family: — 

H.G,, was referred to the Out-patient Department in April of 1932 from the 
Boston City Hospital with the statement that his father had brought him to the 
pediatric clinic because of a personality change following a head injury of 1928. 
\s no fracture had been found then and as a recent physical examination was nega- 
tive the child was thought more suitable for this clinic. He was found to be a boy 
)f ten who had gotten along well until the age of seven, when, after his father had 
given up a grocery store where the boy enjoyed "helping around" and after the 
accident, he had become friendly with a bad group of boys and begun to steal. 
At the age of nine after being a persistent truant and after a " breaking and entering' 
charge, he was sent to the reform school. In a few months he was paroled to a 
farm home and a year later returned to his own home. Soon he began to ' run 
again with the gang", to steal from the Five and Ten Cent Store and to get con- 
stantly into mischief at school. 

On psychological tests he was found to have a normal intelligence and psychiatric 
examination revealed no outstanding pathology. Separation from undesirable 
companions by placement in a foster home and physical upbuilding were the first 
recommendations. 

An effort was made to have the patient sent to the Ford Boarding School for 
Boys. Though a child with a reform school record was not usually taken, it was 
thought an exception might be made for admission in the fall, six months later. 
Patient was taken to visit the school. He liked the idea of going there. Fpr the 
summer months, however, he was placed on a farm under the supervision of his 
parole officer. In the fall he changed his mind. He was so glad to be home after 
the long vacation that he did not want to leave again. As the Ford School an- 
nounced at the same time that their new department in which they had expected 
to place him was not to be opened and as there were no special delinquences, he 
was allowed to remain at home. As the father was not well, being prone to tuber- 
culosis and having had an operation for cancer of the genito-urinary tract, efforts 
were spent in urging him to the Stats Infirmary. He was irritable and cross at 
home, constantly nagging his tired-out wife and six children, forcing the patient 
to stay out of the house most of the time he was not in school. In the winter the 
financial situation became acute; the relief was cut to $14 a week for a family of 
eight. The mother spent unwisely, taking the easiest way of a charge account 
at the store around the corner. The school nurse sent word that the children were 
under-nourished. Then the patient refused to go to school. He was sulky, "like 
a clam", would not talk about his behavior. A talk with him and with the teacher 
resulted in his agreeing to go back to school. The teacher agreed to try harder 
than ever to be friendly with him. In all of her long professional career he had been 
one of the most difficult with whom to make a contact. The father did go to the 
Infirmary but only stayed six weeks, having become disgusted with the doctor 
who told him he could work if he wanted to as there was nothing the matter with 
him. The father then took out his "tension" on the mother and the children. 

In the spring of 1933, one year after the case first came to the attention of the 
department, it was decided to institute intensive work; namely, to get the neuras- 
thenic father out of the family and treat him as a separate unit, to raise the stand- 
dards of the mother's housekeeping (she seemed wilted by her cares and responsi- 
bility), to maintain the happy family relationship existing between the mother 
and the children and the children to one another and to ascertain why the patient 
appeared so maladjusted. Perhaps this should have been a task for the Family 
Welfare Society rather than a psychiatric agency but the former had had super- 
vision for six years during the time when the father had active tuberculosis and 
had given him up as a very difficult person. The mother then had seemed too 
exhausted by the strain of her husband's long illness to improve her standards of 
living. To date, after seven more months, the following results have occurred. The 
father is at a farm home where he has gained much in weight and health. He has 
been given an opportunity to talk out his personal problems with the social worker 
and the doctor. The mother was given two weeks vacation in an attractive home 
where she acquired the energy to tackle the job of rehabilitating her family. In- 



9! 

36 P.D. 137 

creased relief was obtained, the family was moved into a home where there was a 
sanitary bathroom, and a dining room large enough for the whole family to sit 
down at once. Underclothes and household goods were acquired, the mother was 
taken to stores and shown how to buy, instead of being told how and the children ' 
were taught budgeting — all of these environmental aids being thought necessary \ 
before it would be possible to really treat the patient. Already it has been dis- 
covered that he felt he could never eradicate his reform school record. Knowledge 
that his written record will be destroyed at the age of 21 if there are no further 
offenses, has helped a good deal. There has been no truancy for months and his 
report card is excellent showing that he has an urge toward adjustment. One year , 
and seven months of work, many home visits, many school visits, soliciting of funds 
and clothing, hours of travel, just for the purpose of reconstructing a family so 
that a child, who according to his tubercular sister "is a funny one, who goes for 
walks in the country on Sunday, comes back with his hands full of wild flowers, 
puts these into water, will not let anyone touch them, guards them like valuables" 
may have an opportunity to forget his tragic past and may become a useful citizen, i 
The case is far from closed; the father may have to return home when there is no 
more board money, the mother's spurt of energy may disappear but we hope to 
continue until the patient may stand on his own feet. 

F.B., a girl of 19, was referred to the clinic by her mother in the hope that she 
might be sent to the school for the feebleminded. The mother had always been 
ashamed of her, wished she had died at birth instead of existing with a crippled left 
arm due to birth injury. The brothers and sister had been successful. Patient 
was found to have an intelligence quotient of 84%. It was recommended that her 
attitudes toward herself be rebuilt and her confidence restored in the hope that 
she could gain the respect of her family. For one year efforts were made to change 
her habits of idleness through tie up with settlement houses, dancing lessons, elo- 
cution lessons, etc. The patient never could adjust to the fact that she was not 
capable intellectually of work of high order. She always refused the work found ^ 
for her as being too menial. She would not accept anything which necessitated much 
use of her crippled hand. The mother is still disgusted with her. The manipulation 
of environment having failed, an attempt will be made during the following year 
to understand more of the girl's emotional difficulties. She has to live in the com- 
munity being too high grade for institutional placement. She considers the hospital 
workers her only friends and she is not yet ready to adjust by herself. 

During the past year there have been several innovations. We have always been 
troubled because there was not a large enough staff to follow routinely all of the 
patients discharged from the hospital. During the past few months there have 
been fortnightly staff meetings with each service, male and female, to review the 
cases which had been discharged during the previous two weeks, in order to see 
which might benefit by supervision in the community, which might be referred to the 
Out-patient Department, which could be followed by the doctors themselves and 
which needed no supervision. To date there have been eight conferences; 77 cases 
have been discussed; 36 have already been visited by the social service depart-, 
ment. Some were found to be very uncooperative; they wished to forget all about 
the hospital experiences. Their memories were so unpleasant that they could not 
believe that the social worker really wanted to help. As in treatment the point is 
stressed that therapy will be of little value unless the patient desires help, so it was 
decided, after the social worker had made an earnest effort to show the patient and 
his relatives the resources available, to discontinue visiting the patient unless 
assistance was sought. The conferences have been of value as a means of acquaint- 
ing the hospital staff with the fact that the Social Service Department had functions 
other than those of investigation, as is so apt to be the impression gained by the 
staff members who are here for just short periods of time. As the present progress 
of all the cases is presented to the group, each physician has an opportunity to be- 
come acquainted with a larger group of cases which are under long-time treatment 
than if he were hearing only about his own cases from the individual social worker 

Before the above mentioned plan was started, the services of one of the volunteej 
workers was offered the physicians for the follow-up of any cases about whicl:: 



f^.D. 137 



37 



hey desired special information as to present adjustment, or more detailed history 
;han had been obtained at the time of admission. Twenty-five men and 10 women 
vere visited. No effort has made by this worker to carry out a treatment program, 
f such was needed the case was referred to a regular worker. 

The teaching work has been considerably extended. A lecture on social service 
las been given to each group of affiliated nurses during its three months training 
Deriod and to each group of Harvard Medical students during its 11 days period. 
The material given to the latter groups should be coordinated with what is being 
;aught by the social service departments in the other hospitals where the students 
)btain their clinical experience, but as the students do not progress from one 
lospital to another in the same order, this arrangement is difficult. A committee 
)n the Teaching of the Social Aspects of Medicine to Medical Students has been 
created under the auspices of the New England Association of Hospital Social 
Workers. 

When the afternoon clinic for children was started, November, 1932 it was hoped 
;hat intensive social service supervision might be given to all of the cases needing 
t. While only about 30 of the 140 cases are now known to the social service depart- 
nent it is felt that good care has been given the whole group as 66 others are under 
;he care of outside agencies and the remainder are under the supervision of the 
;linic. All of the cases received more time than it is possible to give in the rushed 
norning clinic. It is interesting to note that in contrast with the morning clinic 
)f 1932, 41^0 of the new cases as against 24 came in more than twice and 46% 
)f the old cases in contrast to 34%. 10% of the total referrals in contrast to 4% in 
;he 1932 clinic were from schools and 10 as against 4% from the courts. 

In some instances where the environmental situation is not pathological, namely, 
vhere there is no poverty to account for stealing on the part of the patient, no 
Doverty to increase the tension and worry on the part of the parents, no poverty 
.0 necessitate the mother working, the father being dead, and where the best known 
■nethods of child training have been carried out both by the parents and the social 
vorker and the delinquency has continued, it has been necessary to adopt a new 
-nethod of treatment. It has long been recognized that the treatment of parents 
wrings about improvement in the children, emotional problems and attitudes of 
:he parents being reflected in the children. In order for the parent to receive this 
;reatment it has been necessary to establish a patient-doctor relationship. As the 
ioctor has the treatment of the child as his province and as he feels it will hinder 
lis relationship to the child if the latter thinks that all he says and does will be 
•elated to the parent by the doctor, it is essential to use another therapist. The 
;ocial worker has been chosen for this role. She sees the key parent, either father 
)r mother, several times a week at the hospital and allows the latter to talk out 
lis or her problems, receiving no advice or counselling, using the worker as a screen 
ipon which to project his thoughts until enough material has appeared to given 
:he parent insight into his own difficulties. At the same time his prejudices, dis- 
ikes, thwartings and attitudes acquired in childhood are relived. This "ventila- 
:ion" frequently causes a change in the parent, which permits of better behavior 
)n the part of the child. As this process, which is called "Attitude Therapy" takes 
i long time, at least a year, often two, many cases cannot be so handled. In many 
.nstances ordinary case work methods are sufficient. To date one such case has 
aeen handled by this department with excellent results. 

Again a small sum of money was received from the Junior League of Boston, in 
place of Christmas greens, which has helped in emergency situations. 
I The partial use of an automobile which was given to the hospital in the spring 
t)f 1933 has greatly facilitated the work of the department. 

I As in previous years, excellent cooperation has been given this drpartmont by 
kli members of the staff. 

Kespectfully submitted, 

EsTHKR C. Cook, 

Head S.-rinf Wnrlrr. 



SOCIAL SERVICE STATISTICS 

I. Numerical Summary: 

Male Female 

Children Adults Children Adults 

New cases 114 296 66 233 709 

Renewed from previous year . . 53 30 31 93 207 

Continued from previous year . 20 41 5 8 74 

Total cases carried during year 990 

Closed during year . .135 250 78 207 670 

Continued to following year . 52 117 24 127 320 

II. Sources of new cases: 709. House, 443; out-patient, 266. 
Sources of 74 continued cases: house, 21; out-patient 53. 
Sources of 207 renewed cases: House, 68; Out-patient, 139. 

III. Analysis of work on all cases: 

Number of histories from single sources 81 

Number of investigations from multiple sources 316 

Number of visits pertaining to the supervision of patients in the com- 
munity, either ex-house cases or out-patient cases (does not include 

visits made during course of investigation) 1248 

Number of visits to patients on wards 278 

Unclassified: 

Steering for agencies, interpreters, sending applications to feeble- 
minded schools, etc. 96 

IV. Outstanding social problems: 
Diseases: Mental, 600; physical, 201. 

Personality problems, including temperament, vacillating interests, in- 
stability, etc 367 

Legal problems, including larceny, assault, forgery, etc 248 

Sex problems 162 , 

Environmental: 

Financial difficulties 167 

Employment 92 

Marital difficulties 149 

Unsuittable surroundings, broken home, friction in the home, inade- 
quate physical surroundings, immoral parents 278 

School problems 124 

V. Outstanding social treatment: 

Investigation of court cases with frequent special reporting to probation 
officers: Regular court cases, 214; temporary case and police cases, 60. 

Other investigations, i.e., no informants to come to the hospital, contra- 
dictory statements, etc 123 

Special visits to discharged home cases with advice and counsel 65 

Other House cases under supervision 247 

Total house cases 532 ! 

Total out-patient cases 458 

Contracts not numerically recorded: 

Consultation with agencies — more than ever this year agencies have 
discussed with the social service staff their problems which had psy- 
chiatric import. Cases of patients who were in the hospital many 
years ago have been reviewed with the department by outside agences. 

Placements in private schools, camps, cooperative workshops and 
positions. 

Educational contacts with schools. 

Soliciting of clothing, household goods, money for vacations, convalescent 

homes. I 
Maintenance of a resource file. 

VI. Miscellaneous: 



! 



P.D. 137 



39 



REPORT OF THE PRINCIPAL OF SCHOOL OF NURSING 
To (he Medical Director of the Boston Psychopathic Hospital. 

I herewith present the annual report of the nursing department for the year end- 
ing November 30, 1933. 

Census of the nursing service — Graduate nurses, 12; student nurses, 14; super- 
visors (male), 3; hydrotherapists, 2; female attendants, 8; male attendants, 13. 
Total, 52. 

There have been two changes in the graduate nursing staff during the past year. 
Mrs. Mary Byrne, head nurses, resigned; Miss Parise Padis was appointed. Miss 
Padis is a graduate of Newton Hospital and took the affiliative course here in 1931. 

During the year we received 55 students and 2 post-graduate nurses for the 
three months course in psychiatric nursing. Miss Theresa Hammond, a post- 
graduate student from Ellis Hospital, Schenectady, New Vork, and Miss Dorothy 
Sullivan an affiliate nurses from Cambridge Hospital were obliged to leave their 
first month here, due to illness, and were unable to complete the course. 

Eight groups of student nurses are received here each year for three months 
affiliation in mental nursing. We receive a group of nurses each month for two con- 
secutive months leaving one month out of three in which we do not receive new 
students. This over lapping is necessary in order to have a number of students 
with some experience in the mental work, present on the wards when we receive 
new students. 

We are continually preparing nurses in theory and by demonstrations in order 
that they may have a working knowledge of m?ntal nursing. Although they come 
to us from general hospitals with two or more years experience in surgical and 
medical nursing, yet intelligent handling of mentally ill patients requires a great 
deal of preparation in theory and demonstrations by the instructor of nurses, ward 
supervisors, and the medical staff. 

In a hospital of this type a four months affiliation would be preferable; three 
months theory and demonstrations and one month of practice on the wards free 
of classes, with attendance at staff conference and ward rounds only. The instructor 
of nurses takes each new group for morning lectures and demonstrations for a 
month, while the entire student body attend afternoon lectures given by the physi- 
cians for three months. The afternoon lectures with all the students off the wards 
at one time makes it rather difficult at times to cover the wards and carry on the 
regular routine of admissions, etc. The four months affiliation would relieve this 
condition. The student body is very much in favor of a longer affiliation as it would 
give them more experience in the mental work. The writer intends to interview 
the superintendents of our affiliating schools to see if this can possibly be arranged. 

As in previous annual reports, I must again emphasize the great need of a larger 
nurses home, which would enable us to receive more students or post-graduate 
nurses. In viewing the census of the school it would seem as though we had an 
ample supply of nurses in proportion to patients. However, a closer study of the 
subject would make it clear that this is not so. Our hospital day here is 14 hours: 
night, 10 hours. Graduate nurses and attendants work 10 hours a day with a day 
off each week - students nurses 8 hours a day, 2 hours off for classes and a half 
day off on Sundays. In our routine time schedule with days off, time off, classes, 
lectures, vacations and sickness, there are times when it seems almost impossible 
to supply nurses to escort patients to the numerous clinics, and assist physicians 
who are doing extensive research work with patients, and yet not lose sight of the 
fact that there ought to be enough nurses on the wards to meet emergencies and 
also to give the patients the best possible care. 

The number of patients given continuous baths or wet sheet pack treatments 
afl seen in the following hydrotherapy report is relatively small compared with the 
number of excited patients admitted during the year. Many of these cases were 
physically unfit to be given hydnUherapy treatment, yet were too excited to stay 
in bed, and too ill to be allowed to roam at will. They frecjuently became more 
excited or developed friction sores when placed in restraint. It was often necessary 

hold these patients in bed for hours at a time: this constituted one of our greatest 
nursing problems, as it was not always advisable to keep these patients quiet by 
the use of hypnotics. 



40 



P.D. 137 



Hydrotherapy — tonic baths, number of patients, 244; foot baths, 771; salt' 
glows, 843; electric light baths, 543; saline baths, 131; sitz baths, 130; hot and 
cold to spine, 188; hot and cold to abdomen, 13; tub shampoos, 541; head sham- 
poos, 657; needle sprays, 3,490; fan douches, 3,490; jet douches, 1,399; rain 
douches, 458; scotch douches, 62; massage, 45. Continuous baths, number of 
patients, 372; number of baths, 1,333; number of hours, 9,031. Wet sheet packs; 
number of patients, 34; number of packs, 56; number of hours, 157. Out-patient 
Department — number of patients, 43; foot baths, 31; salt glows, 42; electric 
light baths, 374; saline baths, 6; sitz baths, 4; wet mitt friction, 9; needle sprays, 
522; fan douches, 522; jet douches, 398; scotch douches, 28; massage, 69. In- 
structions in wet sheet packs, continuous baths and tonic baths were given to 54 
student nurses and 1 post-graduate nurse. Number of lessons, 320; number of 
hours, 386. Instructions in wet sheet packs and continuous baths were given to 
14 male attendants. Number of lessons 77, number of hours, 116. 

Respectfully submitted, | 
Mary Fitzgerald, R. N., 

Principal of School of Nursing. 
REPORT OF THE DEPARTMENT OF OCCUPATIONAL THERAPY 
To the Medical Director of the Boston Psychopathic Hospital: 

As in previous years, the Occupational Therapy Department has provided work^ 
for all house patients who are able to come to the work rooms. In addition, then 
assistant does valuable preliminary work with patients on the admitting ward. 

The average patient accepts the work as part of the hospital routine and often 
develops a sincere interest in it. Even if he remains outwardly indifferent, hei 
unconsciously absorbs something of benefit. The former type of patient occasionally 
shows a continued interest by returning to work after he has left the hospital. As 
for the latter, we can only hope that we have given him an added incentive toi 
normal interests. 

For several months in the year we continue to have with us a number of students' 
for a month's training, from the Boston School of Occupational Therapy. The 
association is of mutual benefit and we are glad to have them as many months as 
possible. 

The affiliated nurses also come to us for a short period during their stay, and 
have a chance to gain some insight into the principles of the work. 

The recreational side of our program has consisted of holiday dances in the: 
Assembly Hall, which have been attended by a considerable number of patientai 
and employees. At such times the making of decorations varies the routine workj 

In the spring we also made a puppet for the Marionette Show arranged by the 
Massachusetts Association for Occupational Therapy, in connection with the Annualj 
Meeting of the American Psychiatric Association in Boston. 

At the annual conference of the Massachusetts Association for Occupational 
Therapy, on November 24, examples of our work were on exhibition, and the 
director served on the nominating and publications committeees. 

The personnel of the department is unchanged, Miss Maynard continuing as, 
an able and loyal assistant. 

The statistics of the department are as follows: 

Attendance — women, average attendance, 15; total enrollment, 659. 
Attendance — men, average attendance, 22; total enrollment, 987. 
Articles made, 1,683. Forms printed, 19,650. 

Respectfully submitted, 
Alice E. Waite, 

Head Occupational Therapist. 

PUBLICATIONS FROM THE CLINICAL SERVICE AND LABORATORIES 
Atwell, C. R. and Wells, F. L. — Army Alpha Revised — Short Form. Per, 

sonnet Journal, 1933, 12, October, pp. 160-163. 

Beck, S. J. — Configurational Tendencies in Rorschach Responses. American: 

Journal of Psychology, 1933, Vol. 45, pp. 433-443. 

Beck, S J. — The Rorschach Method and the Organization of Personality! 

American Journal of Orthopsychiatry, 1933, Vol. 3, pp. 361-375. i 



\T>. 137 



41 



Bowman, K. M. — Progress in Psychiatry for 1932. New England Journal of 
Medicine, Vol. 209, No. 9, pp. 451-453, August 31, 1933. 

Bowman, K. M. and Kasanin, J. — Constitutional Schizophrenica. To appear 
n American Journal of Psychiatry. 

Campbell, C. M. — The General Practitioner's Approach to His Nervous or 
Mental Patients. British Medical Journal, December 31, 1932, pp. 1186-1189. 

Campbell, C. M. — Towards Mental Health. Cambridge, Harvard University 
Press, 1933. 

d'Elseaux, F. C. — Use of Carbon Dioxide Mixtures in Stupors Occurring in 
Psychoses. Archives of Neurology and Psychiatry, Vol. 29, pp. 213-230, February 
1933. 

Epstein, S. H. and Lott, George — Lumbar Punctures in Psychothic Patients. 
Journal of Nervous and Mental Disease, Vol. 76, No. 6, December 1932. 

Epstein, S. H. and Hanflig, S. S. — A New Apparatus for Encephalography. 
American Journal of Roentgenology, Vol. 29, No. 5, May 1933. 

Epstein, S. H. — Fever Therapy in Neurosyphilis. Bulletin of Massachusetts 
Society for Social Hygiene, Vol. 3, No. 7, October 1933. 

Merritt, H. H., Moore, Merrill and Solomon, H. C. — The Iron Reaction in 
Paretic Neurosyphilis. American Journal of Syphilis, Vol. 17, p. 3, July 1933. 

Merritt, H. H. and Moore, Merrill — The Argyll Robertson Pupil. Archives 
}f Neurology and Psychiatry, Vol. 30^ p. 357, August 1933. 

Solomon, H. C, Epstein, S. H. and Berk, A. — The Differential Effects of 
^rsphenamine and Tryparsamide. Am£rican Journal of Syphilis, Vol. 17, pp. 45- 
52, Januray, 1933. 

Solomon, H. C. — A Brief Description of Psychiatric Conditions in Massachu- 
setts. American Journal of Psychiatry, Vol. 12, No. 5, pp. 1049-1064, March 1933. 
Wells, F. L. — Learning Functions in an Obscure Amnesia, with Implications 
for Re-education. Journal of General Psychology, Vol. 8, pp. 173-197, 1933. 

VALUATION 

November 30, 1933 
Real Estate 

:.and. 2 acres $59,300.00 

Buildings 511,380.21 

$570,680.21 

Personal Property 

Travel, transportation and oflSce expenses $6,470.33 



?"ood 1,686.73 

Clothing and materials 1,877.58 

furnishings and household supplies 25,067.47 

Viedical and general care 20,726.04 

^eat and other plant operation 795.92 

farm 

^arage and grounds 357 . 15 

flepairs 1,389.34 



$58,370.56 

Summary 

leal estate $570,680.21 

Personal property 58,370.56 



$629,050.77 



FINANCIAL REPORT 
To the Department of Mental Diseases: 

I respectfully submit the following report of the finances of this institution for 
:he fiscal year ending November 30, 1933. 

Statement of Earnings 



Board of patients $8,623.94 

Personal services: 

Reimbursement from Board of Retirement 83.61 

Sales: 

Travel, transportation and office expenses $ . 75 

Food 24.65 

Furniture and houahold supplies 24.90 

Repairs ordinary 11.56 

Repairs and renewals 47 . 70 



Total sales 109.56 



42 



P.D. 137 



Miscellaneous: 

Interest on bank balances $74.52 

Sundries 488.00 



Total, miscellaneous 562.52 



Total earnings for the year $9,379 .63 

Maintenance Appropriation 

Balance from previous year, brought forward $6.957 .63 

Appropriation, current year 209.287 .50 



Total $216,245.13 

Expenditures as follows: 

1. Personal services $148,659.28 

2. Food 20.805.32 

3. Medical and general care 14.429.57 

4. Religious instruction 1,123.30 

5. Farm 

6. Heat and other plant operation 10,568.96 

7. Travel, transportation and oflSce expenses 4.442 . 28 

8. Garage and grounds 2 1 1 . 96 

9. Clothing and materials 1.045 .19 

10. Furnishings and household supplies 3.893.69 

11. Repairs ordinar>' 2.744.86 

12. Repairs and renewals 3.738.51 

Total maintenance expenditures $211,662.92 



Balance of maintenance appropriation, Nov. 30. 1933 $4,582 .21 

Per Capita 

During the year the average number of patients has been, 73.90. 
Total cost of maintenance. $211,662.92. 

Equal to a weekly per capita cost of (52 weeks to year), $55.0803. 
Total receipts for the year. $9,379.63. 
Ex^ual to a weekly per capita of $2.4408. 

Total net cost of maintenance for year (Total maintenance less total receipts). $202,283.29. 
Net weekly per capita. $52.6395. 

Respectfully submitted, 

Elizabeth Libber Shore, 

Treasurer. 



STATISTICAL TABLES 

As Adopted by the American Psychiatric Association Prescribed 
BY the Massachusetts Department of Mental Diseases 



Table 1. General Information 

Data correct at end of hospital year November 30, 1933 

1. Date of opening as a hospital for mental diseases. June 26. 1912. 

2. T>'pe of hospital: State. 

3. Hospital plant : 

\'alue of hospital property: 

Real estate, including buildings 

Personal property 



Total ... 
Total acreage of hospital properly owned. 2 acres. 
Total acreage under cultivation during pre\nous year 
Officers and employees: 



Actually in Service 
at End of Year 



Superintendents . 
Assistant physicians 
Medical internes 

Total ph>-sicians 
Resident dentists 
Graduate nurses 
Other nurses and attendants . 
Occupational therapists 
Social workers .... 
All other officers and employees 

Total officers and employees 



$570,680.21 
58.370.56 

$629,050. 77 



Vacancies at End 
of Year 



M. 


F. 


T. 


M. 


F. 


1 






1 




12 


2 


14 


1 




3 




3 






16 


2 


18 


2 




1 




1 






2 


12 


14 




1 


16 


17 


33 








2 


2 








6 


6 






25 


44 


69 






60 


83 


143 


2 


1 



T. 



IP.D. 137 43 

Note: — The following items. 5-10 inclusive, are for the year ended September 30, 1933. 

5. Census of patient population at end of year: 

Absent from Hospital 
Actually in HospiUl but Still on Books 

White: M. F. T. M. F. T. 

Insane ... . 31 27 58 17 18 35 

Mental defectives . .1-1 _ _ - 

Alcoholics .1-1 - - - 

All other cases . . 8 9 17 14 5 

Total . . . . 41 36 77 18 22 40 

Other Races: 

Insane 2 1 3 3 - 3 

Total 2 1 3 3 - 3 

Grand Total 43 37 80 21 22 43 

Male Female Total 

6. Patients under treatment in occupational -therapy classes, including 

physical training, on date of report 27 14 41 

7. Otherpatients employed in general work of hospital on date of report .2 2 4 

8. Average daily number of all patients actually in hospital during year . 40.51 33 .14 73 .65 

9. Voluntary patients admitted during year 22 19 41 

0. Persons given advice or treatment in out-i>atient clinics during year . 497 509 1.006 

Table 2. Financial Statement 
See Treasurer's report for data requested under this table. 

Note: — The following tables. 3-19, inclusive, are for the statistical year ended September 30. 1933. 



44 



P.D. 



O 



o ^ 

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00 «£> 



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pa, 
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5 ^ 00 o 



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I CO OS CO OS U3 

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U3CO lOOCOSO 1-1 O 

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M O -^00 

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CO CO 



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CO CO 



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CO. 1-1 to Tj« I CO CO CO 



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05 



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bo 
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— — r; 

od ti w 

O O -2 ^ 



t3 
no > 
^ 2 
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1.1 

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■ S ■ E 13 ■ 

. ^ ^ . « m . 

Oi ^ CO 09 ^ 

T3 o; — ca c * ''^ 



D. 

c 13 



'.D. 137 45 



Table 4. Nativity of First Admissions and of Parents of First Admissions 











Parents of Male 


Parents of Female 






Patients 






Patients 






Patients 




Nativity 






























Both 






Both 




M. 


r. 


T. 


Fathers 


Mothers Parents 


Fathers 


Mothers Parents 


nited States 


44 


28 


72 


28 


28 


23 




15 


14 


madai .... 


6 


2 


8 


7 


13 


6 


7 


8 


6 


ngland .... 


~ 




~ 


1 






- 






■ance .... 


1 




1 


1 




1 


- 






ermany .... 


2 




2 


2 


2 


2 


— 






reece .... 


1 




2 












1 


eland .... 


3 


3 


6 


10 


7 


6 


5 


6 


5 


aiy 


5 


2 


7 


7 


7 


7 


3 


3 


3 


3land .... 




1 


1 










1 




ussia ... 


4 


1 


5 


6 


6 


6 


I 

o 


3 


3 


rotland .... 








3 


1 


1 








veden .... 














1 






est Indies* 




1 


1 








1 


1 




ther countries 






1 


1 


1 


1 








nascertained 














1 


1 




Total .... 


67 


39 


106 


67 


67 


54 


39 


39 


35 



^Includes Newfoundland. -fExcept Cuba and Porto Rico. 



46 



P.D. 13' 



CO 



CO 



(N <— -« 



I ^ I ^ fM ^ 
I tS »0 <N — 

I I »*) ^ fs, I I M M 

I — I I I I 

^ CM <*5 •"t <n »H I I I I I 



^ (Nl^ O li^ <N tN fS I I 

(NlOfSTtOOOSOOOaOOtN 
»- (N « vO «0 <N «N f»5 I 



aocoeonoocoQOaga] 
>.>>>.5>>>>>>.>>>>>. 



V 41 



a> 0> ^ 0> ^ ^ ■ 
ig -H (N tN PO CO ' 



I ■»!< a < 

) O lO ^ I 



'.D. 137 



itizens by birth 
itizens by naturalization 
Liiens .... 
itizenahip unascertained 



47 



Table 5. Citi^nship of First Admissions 



Male Female Total 



Total 



44 


28 


72 


18 


6 


24 


5 


3 


8 




2 


2 


67 


39 


106 



Table 6. Psychoses of First Admissions 



Psychoses 



13. 



Traumatic psychoses 

Senile psychoses 

Psychoses with cerebral arteriosclerosis 
General paralysis . 
Psychoses with cerebral syphilis . 
Psychoses with Huntington's chorea . 
Psychoses with brain tumor ... 
Psychoses with other brain or nervous diseases, other diseases 

Alcoholic psychoses 

Psychoses due to drugs and other exogenous toxins, total 

Opium (and derivatives), cocaine, bromides, chloral, etc., alone or 
combined 

Other exogenous toxins .... 

Psychoses with pellagra 

Psychoses with other somatic diseases 

Delirium of unknown origin 

Cardio-renal diseases .... 

Other diseases or conditions 
Manic-depressive psychoses, total 

Manic type 

Depressive type 

Other types 

Involution melancholia .... 
Dementia praecox (schizophrenia) 
Paranoia and paranoid conditions 

Epileptic psychoses 

Psychoneuroses and neuroses 
Psychoses with psychopathic personality . 
Psychoses with mental deficiency 
Undiagnosed psychoses .... 
Without psychoses 



Total 



M. F. T. M. F. T 




7 10 



6 23 



2 10 12 



67 39 106 



Fable 7. Race of First Admissions Classified with Reference to Principal Psychoses 



Race 



\fhcan (black) 
English 
French 
German 




nic» . 
Mixed 

Race unascertained 

Total 



Total 



M. 



67 



F. 


T. 


1 


5 


10 


24 


2 


5 




2 


1 


2 


3 


8 


8 


24 


4 






1 


1 


5 


8 


17 


3'9 


106 



Traumatic 



M. F. T. 



With 
cerebral 
arterio- 
sclerosis 



M. F. T. 



1 1 



General 
paralysis 



M. F. T. 



2 - 
6 - 
4 - 



5 1 



33 1 .14 



With 
cerebral 
syphilis 



M. F. T. 



With other 
brain or 
nervous 
diseases 



M. F. T. 



1 1 
3 4 



1 1 2 



1 - I 



< roatian. Dalmatian. Herzegovinlan. Montenegrin. Moravian. Polish. 

. .tk. Slovenian. 



48 



P.D. 13! 



Table 7. Race of First Admissions Classified with Reference to Principal 
Psychoses — Continued 





Due to drugs 




With 




























and other 




other 




Manic 




Involution 


Dementia 


Undiagnos 


Race 


exogenous 


somatic 


depressive 


melancholia 


praecox 


psychose 






^xins 




d 


isease 


IS 


























M. 


F. 


T. 


M 


. F. ' 


r. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. T 


African (black) 




































English .... 






1 




1 


1 




3 


3 








2 


1 


3 




2 


French .... 
















1 


1 








1 




1 




1 


Gcrrnan .... 












1 


1 




1 


















Greek .... 










1 


1 




















1 




Hebrew 










1 




1 


1 


2 


1 




1 












Irish .... 


1 








2 


2 




1 


1 








6 


4 


10 




1 


Italian! 








1 


2 


3 














2 




2 




2 


Lithuanian . 








1 




1 
























Scotch .... 


























3 




3 






Slavonic* 




































Mixed .... 










2 


2 


1 


1 


2 








3 




3 




4 


Race unascertained 




































Total 


2 




2 


3 


9 


12 


3 


7 


10 


1 






17 


6 


23 


2 


10 1 



'Includes "North" and "South." 

^Includes Bohemian. Bosnian. Croatian, Dalmatian, Herzegovinian, Montenegrin, Moravian. Poli; 
Russian, Ruthenian, Servian, Slovak. Slovenian. 



Table 8. Age of First Admissions Classified urith Reference to Principal Psychos 













Under 




15-19 






20-24 






Psychoses 




Tota 


1 


15 years 




years 






years 








M. 


F. 


T. 


M. F. T. 


M. 


F. 


T. 


M. 


F. 


T 


1. 




1 




1 










1 






2. 


Senile 






















3. 


With cerebral arteriosclerosis . 


1 


1 


2 
















4. 


General paralysis 


33 


1 


34 




1 




1 








5. 


With cerebral syphilis .... 


1 




1 
















6. 


With Huntington's chorea 






















7. 


With brain tumor 






















8. 


With other brain or nervous diseases 


3 


5 


8 


1 1 














9. 


Alcoholic 






















10. 


Due to drugs and other exogenous toxins 


2 




2 


1 - 1 














11. 


With pellagra 






















12. 


With other somatic diseases 


3 


9 


12 
















13. 


Manic-depressive 


3 


7 


10 




2 


1 


3 




1 




14. 


Involution melancholia .... 


1 




1 
















15. 


Dementia praecox 


17 


6 


23 










4 


2 


( 


16. 


Paranoia and paranoid conditions . 






















17. 


Epileptic psychoses 






















18. 


Psychoneuroses and neuroses . 






















19. 


With psychopathic personality 






















20 


With mental dericiency .... 






















21. 


Undiagnosed psychoses .... 


2 


10 


12 






1 


1 




3 




22. 


Without psychosis 
























Total 


67 


39 


106 


1 1 2 


3 


2 


5 


5 


7 


i: 



.D. 137 








49 


Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses — Continued 


Psychoses 


25-29 
years 


30-34 
years 


35-39 
years 


40-44 
years 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


. Senile 

. With cerebral arteriosclerosis 

. With Huntington's chorea . . . • 

. With other brain or nervous diseases. 
. Alcoholic 

K Due to drugs and other exogenous toxins . 

:. With other sotnatic diseases 

Manic-depressive 
, Involution melancholia .... 

Pj^ranoia and paranoid conditions 

1. Psychoneuroses and neuroses 
1. With psychopathic personality . 


1 - 1 


1 1 

- 2 2 


12 - 12 


1 1 1 00- 1 1 - li 

1 1 1 1 1 1 1 1 1 
1 1 1 00— 1 1 — 1 j 


- 2 2 
1 1 

5 2 7 

- 3 3 


- 2 2 
4 1 5 


1 3 4 

2 - 2 


1 2 3 
1 1 2 

1 1 2 




6 8 14 


4 6 10 


15 3 18 


13 5 18 


Table 8. Age of First Admissions Classified with Reference to Principal 
Psychoses — Concluded 


Psychoses 


45-49 
years 


50-54 
years 


55-59 
years 


60-64 
years 




M. F. T. 


M. F. T. 


M. F. T. 


M. F. T. 


1. Traumatic 

3. With cerebral arteriosclerosis 

4. General paralysis 

5. With cerebral syphilis 

6. With Huntington's chorea . . . • 

' 8. With other brain or nervous diseases 

° 0. Due to drugs and other exogenous toxins 

' 2. With other somatic diseases. 

'3. Manic-depressive 

' 4. Involution melancholia 

: 5. Dementia praecox ■ . 

' 6. Paranoia and jjaranoid conditions 

"7. Eii.l.-iui. p«v.ho<.-s 

- g. I'. 1 neuroses 


1 1 1 1 1 1 V. 1 1 1 

1 1 1 1 1 - 1 1 1 1 - 1 1 1 '-71 1 1 1 


1 - 1 

3-3 

1 1 

I - 1 
1 - 1 


1 1 

2-2 

I - 1 

1 1 

1 - 1 
1 - 1 


1 - 1 
1 - 1 


• 9. \\ personality 
, 0. Witii icncy. 

1. Undiagnosed psychoses 

2. Without psychosis . . 


1 - 1 


1 1 2 


- I 1 






6 2 8 


7 2 9 


5 3 8 


2-2 





50 



P.D. 13- 



g-3 



I I 
I I 



^ I — — I 



o 



— -^1 I lull I l>0-l|CM 



— I I I CN 



1—1 I I ID I I I O I O 



(N I r»5 fo »H 1^ I 



1 ■= 



. rt ca rt c *jX3 



p> c.t: F, .t; .t: .t: .t; o g.ti.t! 



• 6 • 

, o a E 



a 



c o 



' rt O 



.D. 137 



51 





H y • - - - - . . :'■ 



52 



P.D. 13' 



Table 11. Economic Condition of First Admissions Classified with Reference t 

Principal Psychoses 



Psychoses 




Tota 


1 


Dependent 


Marginal 






M. 


F. 


T. 


M. 




T. 


M. 


F. 


T. 




Tra 1 1 m a f i r* 




~ 


1 












] 


2, 






















3.' 


^Vith C6r6t)rcil srterios'^lcrosis 


1 


1 


2 








I 


1 


2 


4. 


Gcner3.1 psrs.ysis 


33 


1 


34 


1 






32 


1 


32 


5. 


^Vith ccrcbrfll syphilis 


1 


~ 


1 








I 




] 


6. 


^Vith 1^ u nt ington *s chorcci 




















7. 


With br^in turnor 




















8. 


^^ith other brciin or nervous disccises 


3 


5 


8 








3 


5 


( 


9! 


Alcoholic 




















10. 


Due to drugs and other exogenous toxins 


2 


~ 


2 








2 






11. 


With pellagra 




















12. 




3 


9 


12 








3 


9 




13. 


Manic-depressive 


3 


7 


10 








3 


7 


1 


14. 


Involution melancholia 






I 








1 




IS. 


Dementia praecox 


17 


6 


23 




1 


1 


17 


5 


2: 


16. 


Paranoia and paranoid conditions .... 




















17. 






















18. 






















19. 






















20. 


With mental deficiency 




















21. 


Undiagnosed psychoses 


2 


10 


12 








2 


10 


i: 


22. 


Without psychosis 






















Total 


67 


39 


106 


1 


1 


2 


66 


38 


10* 



Table 12. Use of Alcohol by First Admissions Classified with Reference to Principt 

Psychoses 



Psychoses 


Tota 


I 


Abstinent 


Temperate 


Intemperat 






M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. T 


1. 










1 




1 








.1 


2. 
























3. 


With cerebral arteriosclerosis . 


1 


1 


2 




1 


1 








1 - 


4. 


General paralysis 


33 


1 


34 


13 




13 


16 




17 


4 _ ij 


5. 


With cerebral syphilis .... 


1 




1 


1 




1 










6. 


With Huntington's chorea 




















f 


7. 


With brain tumor 






















8. 


With other brain or nervous diseases 


3 


S 


8 


1 


S 


6 


2 




2 




9. 
























10. 


Due to drugs and other exogenous toxins 


2 




2 


2 




2 










11. 


With pellagra 






















12. 


With other somatic diseases . 


3 


9 


12 




8 


8 


1 


1 


2 


2 - : 


13. 




3 


7 


10 


1 


5 


6 


2 


2 


4 




14. 


Involution melancholia .... 


1 




1 








1 




1 




IS. 




17 


6 


23 


8 


6 


14 


7 




7 


2 - :■ 


16. 


Paranoia and paranoid conditions . 






















17. 
























18. 


Psyc hone u roses and neuroses . 






















19. 


With psychopathic personality 






















20. 


With mental deficiency .... 






















21. 


Undiagnosed psychoses .... 


2 


10 


12 


2 


10 


12 










22. 


























Total 


67 


39 


106 


29 


35 


64 


29 


4 


33 


9 - < 



D. 137 



53 



Table 13. Marital Condition of First Admissions Classified with Reference to 

Principal Psychoses 



Psychoses 


Tota 


1 


Single 


Married 


Widowed 


Separated 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. F. T. 


M. F. T. 




1 


_ 


1 


1 


_ 


1 




































With cerebral arteriosclerosis 


1 


1 


2 


_ 


_ 


_ 


1 


_ 


1 


- 1 1 


_ _ _ 


General paralysis .... 




1 


34 


5 


_ 


5 


26 


1 


27 


1 - 1 


1 - 1 


With cerebral syphilis 


1 




1 




_ 




1 




1 


_ _ _ 


_ _ _ 


. With Huntington's chorea . 
























. With brain tumor . 
























With other brain or nervous dis- 
























eases 


3 


.S 


8 


_ 


2 


2 


2 


2 


4 


_ _ _ 


1 1 2 


.\koholic 
























. D ue to drugs and other exogenous 


























2 




2 


1 




1 


1 




1 






With pellagra .... 
























With other somatic diseases 


3 


9 


12 




1 


1 


3 


8 


11 






Manic-depressive .... 


3 


7 


10 


2 


4 


6 


1 


2 


o 


- 1 1 


- - - 


Involution melancholia 


1 




1 








1 




1 






Dementia praccox 


17 


6 


23 


15 


1 


16 


2 


5 


7 






Paranoia and paranoid conditions 
























Epileptic psychoses 
























Psychoneuroses and neuroses 
























. With psychopathic personality . 
























. With mental deficiency 
























, Undiagnosed psychoses 


2 


10 


12 




6 


7 




4 


5 






Without psychosis 
























Total 


67 


39 


106 


25 


14 


39 


39 


22 


61 


1 2 3 


2 1 3 



Table 14. Psychoses of Readmissions 



Psychoses Male Female Total 

■neral paralysis 1 - 1 

ychoses with other somatic diseases . - 2 2 

anic-depressive psychoses ... 1 2 3 

?mentia praecox 1 2 3 

Total 3 6 9 



ABLE 15. Discharges of Patients Classified with Reference to Principal Psychoses 
and Condition on Discharge 



PSYCUOSSS 


Tota 




Recovered 


Improved 


Unimproved 




M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


M. 


F. 


T. 


Traumatic 


























Senile 


























With cerebral arterioeclcrosis 


























General paralysis 


11 


2 


13 








y 


1 


10 


2 


1 


\ 


With cerebral syphilis. 


























With Huntington's chorea 




























1 




1 














1 






With other brain or nervous diaeatet 




3 


3 










3 


3 










1 


1 


2 








1 


1 


2 








Duf tu drug' and other exoKcnout toxins . 




















































With other somatic disrascn 


I 


2 


3 


1 


1 


2 




1 


I 








Manic-deprrtaive 


2 


4 











1 


4 


5 


I 




1 


Involution melancholia 




3 


3 










3 


3 








Dementia praecox 


J 


6 


9 








\ 


s 


H 




1 


1 


Paranoia and paranoid conditions 


























Epileptic i)«ycho*es 

I'm-. < 'loii.-'ir. .-. - neuroM* 




I 


1 












1 










1 


1 










1 










•rsonality 


1 




1 








1 












' V . 

Without . 

Total . . 




1 








1 


1 








20 


24 


44 


1 


1 


2 


IS 


21 


M 


4 


2 


6 



54 



P.D. 12 



Table 15-a. Hospital Residence during This Admission of First Court Admissioi\ 
Discharged during 1 933 













Average Net Hospitz 




Psychoses 




Number 




Residence in Years 






M. 


F. 


T. 


M. 


F. 


T. 


1. 


Traumatic .......... 


_ 


_ 


_ 


— 


- 


— 


2. 


Senile 


_ 


_ 




- 


- 


- 


3. 


With cerebral arteriosclerosis ...... 




_ 




— 


- 


— 


4. 


General paralysis ........ 


11 


2 


13 


.59 


.25 


.53 


5. 


With cerebral syphilis ....... 








- 


- 


— 


6. 


With Huntington's chorea ...... 


_ 


_ 


_ 


- 


- 


- 


7. 




1 


_ 


1 


50 




.50 


8. 


With other brain or nervous diseases .... 




3 


3 




50 


50 


9. 


Alcoholic 


1 


1 


2 


.50 


^50 


^50 


10. 


Due to drugs and other exogenous toxins 














11. 


With pellagra 


_ 


_ 


_ 








12. 


With other somatic diseases 


1 


2 


3 


.50 


.50 


50 


13. 




2 


2 


4 


.50 


.50 


.50 


14. 


Involution melancholia 




1 


I 




.50 


.50 


15. 


Dementia praecox 


3 


6 


9 


.39 


.34 


.35 


16. 


Paranoia and paranoid conditions 














17. 


Epileptic psychoses 




1 


1 




.50 


.50 


18. 


Psychoneuroses and neuroses 




1 


1 




.50 


.50 


19. 


With psychopathic personality 


1 




1 


.50 




.50 


20. 


With mental deficiency 














21. 






1 


1 




.50 


.50 


22. 


Without psychoses 
















Total 


20 


20 


40 


.54 


.43 


.48 



Table 16. Cause of Death of Patients Classified with Reference to Principal Psychos* 



Causes of Death 


Total 




General 
paralysis 


*.\11 other 
psychoses 




M. 


F. 


T. 


M. 


F. 


T. 


M. F. 


T. 


Epidemic, Endemic and Infectious Diseases 


















Purulent infection, septicaemia .... 


1 




1 








1 


1 


Diseases of the Circulatory System 


















Endocarditis and myocarditis 




3 


3 








3 


3 


Diseases of the Respiratory System 






















2 


2 








2 


2 


Lobar pneumonia 


1 


1 


2 


1 




1 


1 


1 


Other diseases of the respiratory system (tubercu- 


















losis excepted) 


1 




1 


1 




1 






Total 


3 


6 


9 


2 




2 


1 6 


7 



* Includes Group 22 "without psychoses" 



f 



iD. 137 



55 




58 



p.D. i;' 



T/BLE 18. Total Duration of Hospital Life of Patients Dying in Hospital Classifti 

According to Principal Psychoses I 



1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 
10. 
11. 
12. 
13. 
14. 
15. 
16. 
17. 
18. 
19. 
20. 
21. 
22. 



Psychoses 



Traumatic 

Senile 

With cerebral arteriosclerosis . 

General paralysis 

With cerebral syphilis .... 
With Huntington's chorea 

With brain tumor 

With other brain or nervous diseases 

Alcoholic 

Due to drugs and other e.xogenous toxins 

With pellagra 

With other somatic diseases 

Manic depressive 

Involution melancholia .... 

Dementia praecox 

Paranoia and paranoid conditions . 

Epileptic psychoses 

Psychoneuroses and neuroses . 
With psychopathic personality 
With mental deficiency .... 
Undiagnosed psychoses .... 
Without psychosis 



Total 



Total 



M. 



T. 



Less than 
1 month 



M. 



2 2 



2 2 



1-3 

months 



M. F. 



1 1 



1 1 2 



Table 19. Average Length of Hospital Stay during the Present Admission of A 
Cases in Residence on September 30, 1 933 



Psychoses 



1. Traumatic 

2. Senile 

3. With cerebral arteriosclerosis . 

4. General paralysis 

5. With cerebral syphilis .... 

6. With Huntington's chorea 

7. With brain tumor 

8. With other brain or nervous diseases 

9. Alcoholic 

10. Due to drugs and other exogenous toxins 

11. With pellagra 

12. With other somatic diseases 

13. Manic-depressive 

14. Involution melancholia .... 

15. Dementia praecox 

16. Paranoia and paranoid conditions . 

17. Epileptic psychoses 

18. Psychoneuroses and neuroses . 

19. With psychopathic personality 

20. With mental deficiency .... 

21. Undiagnosed psychoses .... 

22. Without psychoses 

Total 



Number 



M. 



13 



16 



Average Length o: 
Residence in Year 



M. 



.45 



.45 



T. 



.45 



2 


1 


3 


.45 


.45 


.45 


1 




1 


.45 




.45 




1 


1 




.45 


.45 




^1 


1 




.45 


.45 


2 




13 


.45 


.45 


.45 


1 




1 


.45 




.45 


6 


8 


14 


.47 


.71 


.60 


2 




2 


.45 




.45 


1 


1 


2 


.45 


.45 


.45 


4 


2 


6 


.45 


.45 


.45 


1 




1 


.45 




.45 


5 


5 


10 


.45 


.45 


.45 


5 


4 


9 


.45 


.45 


.45 


43 


37 


80 


.45 


.51 


.48 



P ublic Document No. 1 37 ^ 



ANNUAL REPORT 



OF THE 



TRUSTEES 



OF THE 



is.. Boston Psychopathic Hospital 



FOR THE 

Year Ending November 30, 
1934 

Department of Mental Diseasi 



Publication op this Documknt approved by the Commission on Administration and Finance 
650. 6-'35. Order 4654. 

OCC U A T . J N AL PRINTIMC PLANT 
DCPARTMCNT OF MENTAL DISEASES 
QARONIR STATt HOSPITAL. 



BOSTON PSYfeiHOPAini^ 3 HOSPITAL 

(Post Office Address: 74 Fenwood Rd.. Boston, Mass.) 

William Healy, M.D., Chairman^ Boston. 
Mrs. Esther M. Andrews, Secretary^ Brookline. 
Carrie I. Felch, M.D., Boston. IfASS 0"'^^I^^TAT 
Channinq Frothinqham, M.D., Jamaica Flam. 
Allan W. Rowe,* Ph. D., Boston. 
William J. Sullivan, Boston. 
Charles F. Rowley, Boston. 

CONSULTING PHYSICIANS 
E. B. GooDALL, M.D., Ophthalmologist, 
G. Philip Grabfield, M.D., Internist. 
Leon E. White, M.D., Oto-Laryngologisi. 
Abraham Myerson, M.D., Neurologist. 
E. B. Sheehan, M.D., Gynecologist. 
John Rock, M.D., Obstetrician. 
J. H. SwARTZ, M.D., Dermatologist. 
T. A. Marlow, M.D., Internist. 
Gilbert Horrax, M.D., Neurosurgeon. 

The staffs of adjoining hospitals 

CONSULTANT IN PSYCHIATRIC SOCIAL WORK 
Mrs. Maida H. Solomon. 



OFFICERS OF THE HOSPITAL 
C. Macfie Campbell, M.D., Medical Director. 
Clifford D. Moore, M.D., Chief Executive Officer. 
Karl M. Bowman, M.D., Chief Medical Officer. 
Frank C. (I'Elseaux, M.D., Senior Physician. 
William L. Holt, M.D., Senior Physician. 
Joseph W. Owen, M.D., Senior Physician. 
John P. Powers, M.D., Senior Physician. 
Oscar J. Raeder, M.D., Senior Physician. 
Harry C. Solomon, M.D., Senior Physician. 
Irma Bache, M.D., Assistant Physician. 
Herbert J. DeShon, M.D., Assistant Physician. 
William F. Green, M.D., Assistant Physician. 
Dorothy Harpham, M.D., Assistant Physician. 
Paul Haun, M.D., Assistant Physician. 
Mary Palmer, M.D., Assistant Physician. 
Grosvenor B. Pearson, M.D., Assistant Physician. 
Paul M. HowARi). M.D., Medical Interne. 
HARR-i. M., Salwjh, M»D., Medical Intern^. 
Olive C. Smith, M.D., Medical interne. 

, Chief of Neuropathological Laboratory. 

Anna M. Allen, M.I).. Acting Chief of Neuropathological Laboratory^. 

Whitman JKv Coffin, M.D., Roentgenologist.. 

Peter J. Dalton, D.M.D., Dentist. 

F. L. Wells, Ph.D., Head Psychologist. 

Mary Fitzgerald, R.N., Principal of School of Nursing. 

Esther C. Cook, Head Social Worker. 

Alice E. Waite, Head Occupational Therapist. 

Mrs. Elveretta Blake, Librarian. 

Anna F. Caulfield, Treasurer. 

♦Deceased. 

>By arrangement with the Department of Mental Diseases. 



P.D. 137 A ^ 

CONTENTS 

PAGE 

Report of Trustees 3 

Report of Medical Director 4 

Report of Chief Executive Officer 18 

Report of Out-Patient Department 19 

Report of Chief Medical Officer 23 

Report of Biochemical Laboratory 25 

Report of Psychological Laboratory 26 

Report of Neuropathological Laboratory 28 

Report of Department of Therapeutic Research 29 

Report of Social Service Department 33 

Report of Principal of the School of Nursing 36 

Report of Department of Occupational Therapy 38 

Publications from the Clinical Service and Laboratories 38 



REPORT OF THE TRUSTEES OF THE BOSTON PSYCHOPATHIC 

HOSPITAL 

To His Excellency the Governor, and the Honorable Council: 

Perusal of this annual report cannot fail to convince that the amount and 
quality of the work done at the Boston Psychopathic Hospital justifies the confidence 
and respect in which the hospital is held by the medical profession and the general 
public. The volume of a year's activity is impressive; no less than 2,000 patients 
received the benefit of scientific study on the wards, a certain number of these 
remaining considerable lengths of time for treatment. The accumulation of medical 
data on these ward patients and the compilation of diagnostic and advisory reports 
represents a huge task. To the out-patient department came 775 new patients, 
while 314 received intensive treatment in the clinic for neurosyphilis. 

The quality and the varieties of service rendered are witnessed to by the director's 
report and the individual communications of the several heads of departments. 
Again we would call attention to the extraordinary achievements of the Depart- 
ment of Therapeutic Research where, under Dr. Solomon and his colleagues, 
syphilis of the central nervous sytem is being treated in one of the world's most 
notable clinics. The social service aspects of this work with its follow-up neces- 
sities, mainly the result of the unremitting zeal of Mrs. Maida Solomon who for 
eighteen years has volunteered her services, have proved exceedingly valuable for 
successful medical treatment and social adaptation as well as from a research 
standpoint. 

We congratulate ourselves on our new laboratories made possible by a generous 
gift from the Harvard Medical School and the indefatigable efforts of Dr. d'Elseaux. 
The new space, the new equipment and Dr. d'Elseaux's enthusiastic program 
promise well for increased output of research. 

Up to the present some 418 pupil nurses from other hospitals have come to us 
for educative training and experience in nursing mental cases. This program of 
affiliated service, now nine years old, is a boon to the nurses themselves, to their 
service in general hospitals in which problems of mental disorder inevitably crop 
up, and to the public who often need nursing service for mental cases. 

Work done at the hospital by medical men on fellowships and not on our staff 
continues to be highly desirable. Some of them bring special technical training 
and some are engaged in important pieces of research. 

There are many improvements which we desire, particularly on account of our 
building yearly growing more outmoded and gradually becoming a little more 
decrepit. Any projects that would make considerable alterations or extensions 
possible would be highly welcomed by us. 

Once more we insist that the good work of this hospital is largely due to the 
special loyalties of the staff to the ideals of the hospital and to the fine relationship 
that exists between the director and the chiefs of departments, particularly Dr. 
Bowman and Dr. Solomon who have been with us so many years. That there is 
so little to criticize in the care of patients or in other features of the management 
of the hospital is due to their splendid professional and personal attitudes. 



1 



4 P.D. 137 

Through the death of Dr. Allan Winter Rowe we stand under the shadow of the 
loss of one of our most active and valuable members. On our records we have 
inscribed a memoriam to this noted scientist and true friend of our hospital. 

Respectfully submitted, 
William Healy, Chairman Chaxning Frothixgham 

Esther M. Axdrews, Secretary Ch,\rles F. Rowley 

Carrie I. Felch William J. Sullivan 



MEDICAL DIRECTOR'S REPORT 

To the Board of Trustees of the Boston Psychopathic Hospital: 

In accordance with the provision of the statutes I submit for your consideration 
the report for the statistical year ending September 30, 1934 and for the fiscal 
year ending November 30, 1934. 

The Role of the Bostox Psychopathic Hospital 

The Boston Psychopathic Hospital has three main functions: (1) that of a 
special health service to the residents of metropolitan Boston and to patients from 
other districts of the Commonwealth who for various reasons may be referred to 
this hospital; (2) research into the nature and causes of insanity and into its pre- 
vention and treatment; (3) instruction of physicians and medical students in the 
principles and practice of this specialty of medicine, and of psychologists, nurses, 
occupational workers, social workers in the special problems pertaining to this field 
of medicine. 

In carrying out its function of service to the sick the work of the Boston Psycho- 
pathic Hospital covers a somewhat broader field than does the general hospital, 
while it does not make claim to the same intensive study and treatment of the 
varied disorders of the bodily systems which are dealt with in the general hospital. 
In the latter the patient can often be adequately treated as an isolated unit without 
much reference to his personality, his past experiences, the economic and soqial 
environment in which he lives. It is otherwise with the patients of the Boston 
Psychopathic Hospital. In each patient an adequate review has to be made [1) 
of the bodily functions: (2) of the personality of the patient: i,3 of the social en- 
vironment which has influenced his personality and which exposes the individual 
to special stresses and strains. This tripartite task is present in the case of every 
individual patient, although, the importance of the three aspects varies from case 
to case. In some patients the problem of the disorder is solved by a thorough study 
of the bodily functions. This is, for example, the case in many patients suffering 
from mental symptoms associated with infectious diseases, severe anaemia, heart 
disease, respiratory disorders, glandular conditions, structural damage of the brain, 
poisons of organic or inorganic nature, with special deficiencies of diet as in pellagra. 
In other cases the simpler bodily functions do not seem to be primarily at fault, 
the trouble seems to be at a more complex level. Even though the body be robust 
the individual may have a personality ill equipped to cope with the ordinary trials 
and vicissitudes of life. The appetites may be insubordinate, the emotional life 
may be rather explosive, imagination may tend to run riot, a healthy bond with his 
fellows may be difficult to establish, a feeling of response to broader social needs 
and to spiritual values may be lacking. The attempt of such an individual to 
establish a stable personal equilibrium and a tolerable relationship to his immediate 
environment may be unsuccessful and the result may be in some cases a transitory 
mental disorder, in others permanent failure to adapt behaviour and beliefs to the 
restrictions of social life. 

In the third group of cases environmental influences may play a dominant role. 
In these cases, even with a fairly satisfactory physical endowment and with a per- 
sonality which under happier circumstances might have maintained an acceptable 
balance, the special circumstances of life may bring about transitory periods of 
turmoil or a permanently twisted or inefficient mode of life. The early atmosphere 
of the home, the penetrating influence of parents, incidental experiences of failure, 
the absence of a satisfactory outlet for native skill, the absence of constructive and 
supporting social comradeship, the intoxication of special individual and group 
influences may be the outstanding causal factor of the individual disorder. 



P.D. 137 



5 



From the point of view of service to the individual patient, the bodily, personal 
and social aspects of each case have to be scrutinized. In each one of these fields, 
in addition to the practical aspect of the survey, there is the opportunity to the 
spirit of scientific curiosity to utilize observations to increase our existing stock of 
knowledge and to contribute something to the answer of unsolved problems. The 
service to the patient would be a poor service if the spirit of scientific curiosity were 
absent and if the physician considered his problem to be merely the identification 
of recognized types of disorder and the recommendation of a routine treatment. 
Adequate service requires the recognition of what is special to the individual case 
as well as its general type. It requires not only the recognition of what is familiar 
but also sensitiveness to what is individual and unfamiliar. For adequate service 
the patient must be accepted as an individual with his own special challenge: what 
is unfamiliar in the individual case must not be discarded as merely incidental and dis- 
concerting from the point of view of an orderly system but must be carefully con- 
sidered and thoughtfully studied. Even what is familiar is not necessarily well 
understood. Familiarity tends to breed a certain indifference and the physician 
has to remain continuously conscious of how little is actually known of the real 
meaning of many of the familiar groups of symptoms to which he can so easily 
attribute learned names. 

•Curiosity as to the meaning of familiar symptoms and as to the importance of 
unfamiliar symptoms motivates precise observation, the collection of relevant 
data, the formation of tentative explanations and the submission of such explana- 
tions to confirmation by further observation or by experimental methods. Thus 
in the sick room scientific curiosity finds special topics of investigation and carries 
on research into those phenomena which are the special marks of sickness. There 
is a tendency to look upon research as somewhat remote from the ordinary work 
of the physician- The first association of the term research in the minds of most 
people would be laboratory. Research in the laboratory, however, while employ- 
ing detailed, precise and highly specialized methods, is but the attempt to carry 
on still further the analysis of a problem presented at the bedside. Intelligent 
work at the bedside is a prerequisite for the work in the laboratory; before an 
answer to a question is sought it is well that the question should be an intelligent 
one and formulated in precise terms. For practical purposes, where the use of the 
microscope and of special chemical tests is required, the full investigation of the 
patient may be carried on in two stages, in the ward and in the laboratory. While 
there may be some structural division between ward and laboratory, there should 
be no corresponding mental division in the mind of the physician. In the quest 
for knowledge the physician should think of the ward and the laboratory as one. 

As service to the patient should not be divorced from the attitude of scientific 
investigation or research, so service to the patient is closely interwoven with prob- 
lems of teaching. It is generally agreed that in a hospital where teaching is one of 
the recognized activities patients are most intensively studied. Teaching demands 
clarity of thought and of formulation, it challenges the exact status of our knowledge 
at any given time, it brings up for discussion those factors which are still of un- 
certain meaning, it brings to a focus the varied facts which bear upon the condition 
of the patient. The questions and the direct observations of the alert student 
whose interests have not been stereotyped by familiarity with standard doctrines 
may be very illuminating to the teacher. In discussion between teacher and 
students the condition of the patient becomes more definitely formulated, the 
causes of his sickness are more precisely appreciated, the exact value of different 
forms of treatment are critically scrutinized. 

It is, therefore, of value to the patients in the Boston Psychopathic Hospital 
that those responsible for their care carry out their work in an atmosphere of free 
discussion with colleagues, recent graduates and medical students. 

In the various departments, in the psychological laboratory, in the social service 
department and in the nursing group there is the same association of those directing 
the work and of a continual stream of students who bring the stimulus of fresher 
points of view and eager curiosity. 

In the general body of this report the special work which is going on in the 
various departments is outlined in some detail. It may be appropriate, however, 
here to give the broader background of these more special reports, and to indicate 



6 P.D. 137 

in a general way the practical work of the hospital and its significance for the 
community. The statistical tables at the end of the report give detailed figures 
of the kind traditionally associated with an annual report. To the average reader, 
not interested in technical details, these figures may have comparatively little 
meaning. It has, therefore, been the custom in the annual reports from the Boston 
Psychopathic Hospital to make reference to a few concrete examples of the actual 
work so that the reader of the report may realize how many practical issues of life 
are touched by this work. These few examples may help to transform the skeleton 
of a statistical table into a living reality and enable the citizen to see behind book- 
keeping figures fellow-beings in distress of body and of mind. 

One may first present very briefly two patients in whom the essential problem is 
one of bodily sickness, although the symptoms have been of such a nature as to 
lead to their admission to the Boston Psychopathic Hospital. 

A young woman was admitted from another hospital owing to mental confusion, 
an attack of screaming, ideas that people were operating on her and behaving in a 
strange way. The mental symptoms had developed immediately after her baby 
was born. On admission the patient had a high fever and was suffering from 
pyelitis. The important medical problem was to deal with the infectious condition. 

In this case the centre of interest was not the special emotional and other per- 
sonal problems of the patient but the impersonal problem of infection and the 
practical steps necessary to deal with the infection. As soon as the patient pre- 
sented no special difficulty in general management she returned to the general 
hospital for the continued treatment of her physical ailment. Her physical health 
was restored sooner than her mental health, and two weeks later she had to return 
to the Boston Psychopathic Hospital as she was still disturbed emotionally and had 
many odd ideas. On her readmission her physical condition required very little 
special supervision and the main problem was now that of helping the patient to 
regain her emotional balance and her normal objective outlook. Ten weeks after 
readmission the patient was quite herself and returned home. 

A man in the prime of life was picked up on the streets while roaming about in 
the rain in the outskirts of Boston after midnight. He poured out a detailed 
story about friction with his relatives, his determination to regain the custody of 
his child, impulsive and apparently ill-considered appeals which he had made to 
various people during his overactive condition on the day previous to admission. 
He was overtalkative, self-assertive, somewhat resentful and accusatory. 

^The patient's loss of balance, his impulsive determination to carry out certain 
plans, his self-assertiveness seemed to be closely related to a breakdown in his 
physical health. He had symptoms of an overactive thyroid gland; he had well 
marked heart disease. 

The problem for the physician consisted in outlining treatment for the thryoid 
and heart condition, while the review of the patient's emotional life and special 
attitude received less attention. As the physical condition improved the general 
mental balance and outlook became very much more satisfactory. 

A quite different problem from those presented by the previous patients with 
bodily ailments and secondary mental symptoms is presented by the following cases. 

A woman of fifty was indulging in eccentric religious behaviour. She walked 
about the church without her shoes, she wanted to kiss the right hand of everyone, 
she talked of a crown of glory awaiting her at midnight. This peculiar behaviour 
was not explained by any physical disorder; the patient was in good physical 
health, had no appearance of being ill, was quite robust. 

The patient was a single woman of moderate education who had come to this 
country at the age of twenty-six and done simple domestic work for many years. 
She had lived a rather lonely life and had made few social contacts. She seemed 
to prefer the company of her own sex and never expressed any desire to be married. 
She was a devout church-goer. This rather lonely woman, with regard to whose 
inner life little was known, began suddenly to show the extreme religious behaviour 
which led to her admission to the hospital. In the hospital the patient kept very 
much to herself, was quite preoccupied with her religious procedures and with 
various unexplained rituals. She claimed that she was a saint and was making a 
retreat in a convent to atone for the sins of others. She claimed that she was 
married to a husband who had money and that she still consulted him day and night. 



P.D. 137 



7 



In this case the mental disorder of the patient seemed to have no relation to 
any breakdown of the ordinary bodily functions but to be the expression of the 
underlying wishes for personal happiness and for spiritual value of a woman whose 
real life had furnished her very few of the satisfactions which human nature craves. 
The mental disorder supplied her with what reality had denied her. The fact that 
she had got inadequate satisfaction from real life was not to be attributed so much 
to unfavorable external circumstances as to the limitations of her own personality. 

In another patient the cravings of the patient were of a more mundane nature, 
but here too the mental disorder consisted essentially in her insistence on living 
out the creations of her phantasy as if they were real. The patient, an efficient 
office worker, a somewhat seclusive individual, had been much preoccupied with 
the desire to marry the right sort of man. She had apparently been somewhat 
exigent in her demands. Her social life was very restricted. During a period of 
unemployment her ability to hold her phantasies in check and to retain her critical 
ability seems to have deserted her for she conjured up a most romantic situation in 
which wealthy suitors were taking elaborate precautions to notify her of their 
whereabouts. On account of her behaviour, which was in keeping with these 
phantasies, she was brought to the hospital. 

The following case illustrates that group of patients in whom there is no evidence 
of a specially unstable personality nor special physical ailment, but where the 
personality succumbs to unusual demands made upon it. 

The patient, a woman in the prime of life, was brought to the hospital after 
attempting suicide. The suicidal attempt was apparently not due to any serious 
constitutional tendency towards depression but due to her inability to deal with 
particularly trying experiences. Sometime previously her husband, owing to 
financial depression, had committed suicide under circumstances which left her 
with a certain feeling of guilt. She tried to gain peace of mind by seeking all types 
of recreation and led an active social life, in the course of which she had a love 
affair with a man, marriage with whom was impossible. She then lost her only 
surviving child. Since the death of her husband she had ruminated over the 
possibility of suicide and had even made one attempt but now, after the death of 
her child, the accumulated circumstances led her to make a much more serious 
attempt, after which she was admitted to the hospital. 

In the light of such a case one scrutinizes the resources of human nature for 
dealing with the serious emergencies of life and considers what are the educational 
forces which may train the individual to meet such difficulties and what are the 
resources of the community which may support the individual through such trying 
periods. 

A man in the prime of life had been a bright and sociable individual, efficient in 
business, interested in literature and current events. In the thirties he found that 
his wife had been unfaithful to him during his frequent absences. He obtained a 
divorce. After his divorce he established relations with another but with no bond 
of affection. During the past two years the general economic situation made it 
impossible for him to carry out his financial obligations. He became despondent, 
felt that he was worn out, wished he was dead. He was further depressed by a 
somewhat serious diagnosis given him by a physician. 

The patient came of rather unstable stock and his breakdown was no doubt 
to a certain extent, determined by his individual vulnerability. On the other hand, 
the actual incapacity seemed to have been definitely precipitated by a series of 
external circumstances for which he had little responsibility. 

In the individual case one is dealing with a complex group of forces and it is 
seldom that one can clearly isolate one single factor which is responsible for the 
total problem presented by the patient. Bodily symptoms may be present, but 
the general stability of the individual is also, as a rule, of some importance. The 
personality may be somewhat vulnerable or unstable but external stresses usually 
play a considerable role in the development of the actual disorder. In each cfese 
one has to do what is possible to attribute its respective role to each of the three 
factors, the bodily factor, the personal factor, the environmental factor. 

There are two groups of mental disorders which not only present interesting 
problems with regard to fundamental biochemical and physiological processes and 
with regard to the personality of the individual with his complex urges and needs, 



8 



P.D. 137 



but which have unusual economic and social importance and which are intimately- 
related to the codes, the customs and the organization of the community. These 
two groups are the syphilitic psychoses and the alcoholic psychoses. Dr. Haven 
Emerson has recently in no uncertain terms given his views as to the responsibility 
of the community and of the medical profession for dealing with these problems 
(Presidential Address before the American Public Health Association at Pasadena, 
California, Sept. 3, 1934). The syphilitic and the alcoholic psychoses together 
present a large percentage of the total case-load of insanity which is such a burden 
to the community as a whole. The syphilitic psychoses and the alcoholic psychoses 
are above all others preventable disorders. Their prevention, however, is not a 
question of some administrative measure which can be carried out by a govern- 
ment bureau and its personnel, it is a challenge to the intelligence and the con- 
science of the community as a whole. The attitude of a community towards these 
disorders and the measures for their prevention adopted by the community may 
be a useful index of the real cultural level of a community. 

Syphilitic Psychoses 
This is not the place to take up the broad question of the prevention of syphilis, 
with all the complexities of individual psychology and of social organization in- 
volved therein. 

In regard to the treatment of syphilitic mental disorders the present generation 
has seen steady and uninterrupted progress. A generation ago the diagnosis of 
general paralysis or paresis which is one form of brain syphilis meant a sentence to 
death within two to five years. At the present time such a diagnosis made at the 
Boston Psychopathic Hospital has a much less gloomy outlook. One-third of the 
patients thus diagnosed and treated appropriately are expected to return to their 
previous level of work and social efficiency. Another third may not be capable of 
such a complete cure but will be able to retain over a prolonged period a condition 
of reduced efficiency and moderate well-being. 

In this pioneer work in treatment no one in this country has been more active 
than Dr. Solomon. Dr. Solomon has for over twenty years followed every pro- 
mising line of treatment, has carried out independent investigations, has carefully 
analyzed the observations which he has so industriously collected. His report 
shows in some detail how a bedside problem if attacked in a spirit of scientific 
curiosity takes the physician from the ward to the laboratory, where he can with 
special apparatus and measures of precision probe more deeply into the nature of 
the incapacity of the patient, a sickness which in its turn has been determined by 
the cravings of human nature and by an unsatisfactory social environment. 

Alcoholic Psychoses 
At the Boston Psychopathic Hospital there are admitted a constant stream of 
cases in whom the abuse of alcohol plays an outstanding role. To the physician 
these patients present many interesting problems both with regard to the bio- 
chemical and physiological reactions and with regard to the psychological equili- 
brium of the patient. These patients, however, are more than special problems 
for the physician, they have an important significance to whoever is iriterested in 
sociological problems or in the welfare of his fellow-men and the organization of 
the community. 

The alcoholic psychoses are not to be looked upon as merely a technical problem 
for those interested in brain pathology. They represent human lives distorted and 
crippled on account of a complexity of factors, social as well as individual. The 
significance of this whole problem may be illustrated by presenting in a most 
summary form an unselected series of these cases admitted within a single month. 

A.B., an artisan in the thirties, had been a difficult boy, a truant at school. After 
his war service he had many jobs, but during the depression had been out of work. 
From the age of eighteen he had a series of arrests for drunkenness and he had 
spent some time in the House of Correction, had been several times on probation. 
He was twice married and had two children whom he terrorized when under the 
influence of alcohol. He said "they are my kids, I can do with them as I like." 
The patient was sent to the hospital from the court where he had been taken after 
prolonged brawling. 



P.D. 137 



9 



This patient had been allowed to remain in the community during all these years, 
inefficient and a source of discord, with two little daughters exposed to the con- 
tamination of his influence. Children would not be allowed to live without very 
special safe-guards in a house where there is a case of scarlet fever or other ex- 
anthematous disorder, but the community tolerates the exposure of these children 
during the formative years of childhood to the influence of such a parent. 

B.C., an ex-police officer, had two years previously been discharged from the 
force on account of his drinking (quis custodiet custodes?). He was brought to the 
hospital after a prolonged debauch and a self-injury of possibly suicidal nature. 
His physical condition showed tremor, enlargement of the liver, bronchitis, evi- 
dence of blood in the stools. The patient had been drinking from the age of sixteen. 
His three children were being brought up in the home of this man. 

CD., a man in the thirties, living the hard life of a fisherman, used his periods 
at home for periodic debauches of drinking. He finally became afraid and de- 
veloped many terrifying delusions. 

To what needs did alcoholic indulgence respond in this case? What alternative 
sources of satisfaction were available? What social contacts with any constructive 
value were at hand? 

D. E., the wife of the preceding patient, had lived a sober life until her marriage 
to this second husband. Apparently due to his influence she began to drink to 
excess and finally developed marked delusions. 

E. F., a salesman in the forties, who for many years used alcohol to excess, was 
admitted in a condition of delirium. 

F. G., a salesman in the forties, suffering from circulatory disease, had been 
drinking heavily for eleven years. A young son had been brought up in this 
atmosphere. The patient had been taken to court on account of brawling at home 
and was referred to the hospital. 

G. H., a war veteran in the thirties with some evidence of organic involvement 
of the central nervous system, had since the war been unable to work steadily, 
had finally become irritable, his personality changed. He began to drink in order 
to be sociable and became at times threatening and destructive. Two children 
were being brought up in the unwholesome atmosphere of the patient. 

H. I., a laborer, had lived a simple uneventful life but had always been accus- 
tomed to drink socially although apparently he was sensitive to alcohol and re- 
acted in an excessive way. There was some evidence of involvement of his kidney 
and liver. The patient was brought to the hospital after a weekend spree in which 
he became afraid that he would harm himself. 

I. J., a man in the thirties, had from an early age been associated with the liquor 
business. During the past fifteen years he had been in many hospitals on account 
of mental trouble due to drinking. Owing to his disorderly behaviour, general 
attitude and apparent deterioration of personality he was brought to the hospital. 

In this case one sees a young man with good endowment, with satisfactory 
education and with favorable economic and social circumstances, begin in the 
twenties to indulge to excess in alcohol and steadily to eliminate all that gives value 
to the human personality. 

J.K., as a young man had the ambition to enter the religious life but did not have 
the necessary stability for this career. He later entered the police force but began 
to drink on his time off, and the consequent irritability and morbid attitude made 
it necessary for him to leave the force. 

K.L., a salesman of thirty-eight from the middle West, had been acting in a 
threatening manner under the influence of drink. He had been out of employ- 
ment; his wife had deserted him. The patient refused to discuss any of his per- 
sonal troubles which possibly were closely connected with his alcoholism. The 
patient was an only child, the parents had separated; the patient's father was 
alcoholic. 

L.M., a counter-man of thirty, had been drinking since the age of nineteen. He 
tended to worry over certain misdemeanors and claimed that he drank in order 
to forget his mistakes. After a period of unusually heavy drinking he began to 
feel that he was suspected of certain notorious crimes. He began to hear voices 
and finally made a suicidal attempt. 



10 



P.D. 137 



M.N., a prosperous business man in the fifties accustomed to go on sprees, during 
one spree actually developed various delusions and made rather dangerous pre- 
parations to defend himself. The patient was in a good position, a married man 
with two grown children. The blood gave a positive Wassermann test but there 
was no evidence of the central nervous system being involved by the syphilitic 
process. 

N.O., a young man in a fair economic position, before going to visit his wife in 
the Lying-in Hospital where she had just had a baby, took a few drinks. He had 
no memory of what happened after that but apparently he attempted to wreck a gas 
station, having become wildly delirious. The patient had of late begun to show 
increasing sensitiveness to the use of alcohol. He claimed that he drank to escape 
worry over responsibilities. The sex life was of importance; his wife had frequently 
refused to have sexual relations on the basis of having a family as large as they 
could adequately care for. 

This case illustrates the inter-dependence of various factors, the personal sus- 
ceptibility, the disturbed sexual situation, the patient's reaction to this, the 
pharmacological influence of the alcohol. 

O.P., a laborer, forty-six years of age, had been discharged from the hospital 
three weeks previously after an attack of delirium tremens. Two weeks after dis- 
charge he resumed drinking and acutely developed delusions that people were 
going to cut his legs off; owing to these delusions he went to the police station. 

P.Q., a laborer of twenty-nine, previous to admission had been nine times in the 
police court on account of drunkenness. In his drunken attacks he was apt to be 
very destructive. The patient was sent to the hospital by the court. Three chil- 
dren were being brought up under the influence of this poorly endowed and alcoholic 
parent. 

Q.R., a machinist, forty years of age, since the World War had been accustomed 
to drink to excess. His alcoholic indulgence had appare*ntly led to his marriage 
with a dissolute woman. He was admitted to the hospital in a delirious condition. 

R.S., a clerk of thirty, had for the year before admission been constantly drinking. 
He had begun to drink during his college career. During the year of excessive 
drinking previous to admission he had been behaving in an eccentric way and 
passing worthless checks. There was no special physical condition nor external 
difficulty to explain the patient's behaviour. He was a college graduate. 

To the physician interested in the bodily processes and the reaction of the system 
to deleterious influences or to the absence of essential supplies, the disturbance of 
the bodily economy in chronic alcoholism offers many intriguing problems. Dr. 
Robert Fleming has in the laboratory of the hospital been carrying on special 
investigations on the course of the alcohol after introduction into the system, be- 
ginning with an inquiry into its entry into the blood stream and into the cerebro- 
spinal fluid. One looks forward to further investigations on the nature of the 
general disturbance of nutrition, of the changes in the stomach and in the liver 
functions, of the factors involved in the production of neuritis. 

Alcoholism is, however, not merely an impersonal or physiological problem, it 
has to be looked upon as part of the conduct of the individual. The factors which 
lead a person to adapt himself to life in this way are even more worth attention 
than the nature of the physiological effects of alcohol. No single formula can be 
offered in interpretation of alcoholism as a form of personal behaviour. From 
ancient times and in all climes alcohol has been utilized to exalt the mood in keeping 
with the needs of special situations. The individual may appeal to alcohol to 
modify physical pain, to heighten imaginative activity, to improve social contact. 
It is intelligible, therefore, that human nature with its complex organization, with 
its inhibitions, tensions and restrictions should eagerly exploit the possibilities of 
alcohol. It is perhaps not surprising that the individual should continue to do so 
even when the probable price is a transitory mental disorder, permanent impair- 
ment of memory, distortion of one's personal relations, deterioration of moral 
fibre, the development of a social atmosphere which is detrimental to one's fellows 
and poisonous for one's children. 

In the individual case the physician has the problem not merely of caring for the 
physical symptoms and the temporary mental disturbance but also of making a 
thorough review of the personality of the patient, of taking stock of its assets and 



P.D. 137 



11 



liabilities and of giving the patient this opportunity of doing some constructive work 
with regard to his later career. Such a procedure is time-consuming and requires 
the hearty cooperation as well as a certain level of intelligence on the part of the 
patient. In some patients there is no longer or may never have been any keen re- 
sponse to the moral issues involved in the conduct of the individual life, and the 
ofier of the physician may mean nothing to the patient. 

The alcoholic patient brings to the attention of the physician problems which 
are broader than those of the individual personality, its driving forces and inner 
conflicts. The alcoholic lives as a member of a social group ; his alcoholic indulgence 
is not to be looked on merely as the reaction of an organism which can be studied 
in isolation; it is the behaviour of an individual living in a certain community with 
its traditions, its institutions, its beliefs, its social habits. Alcoholism forces us to 
consider what are the needs of human nature and what are the available means 
of satisfaction. The individual is liable to have external as well as internal diffi- 
culties. The internal difficulties depend on conflicts of appetites, instincts, emo- 
tions, aflFections, ambitions, ideals. The external difficulties may consist of material 
hardships, uncongenial and exhausting work, a drab environment, lack of cultural 
amenities, experiences of failure, unsympathetic or hostile contacts. Pain, poverty, 
bereavement may have to be dealt with. The physician has to consider not only 
how he may strengthen the body of his patient but how far he may modify inner 
tensions and how far he may bring social support to the individual. In some cases 
he may be of considerable use through his personal contact with the patient, but 
for the continued maintenance of the equilibrium of the patient there must be a 
program of life and circumstances which bring to the individual a certain degree 
of satisfaction, which make life tolerable with a balance on the credit side of the 
account. 

When the patient leaves the hospital he must find tolerable conditions of work and 
recreation: he is entitled to satisfaction from work accomplished, pleasure in the 
application of personal skill, some social contact which will give his individual reso- 
lution the support of group opinion, some contact with a group whose views of life 
and general code and periodic meetings keep alive in him beliefs, which give to his 
life a certain savor even in the midst of transitory or prolonged difficulties. The 
alcoholic who leaves the hospital has little chance of living a worthy life unless 
there is some reasonable organization of the community so that his fundamental 
human needs will be satisfied to a modest degree. 

Ox THE OuT-PaTIENT DEPARTMENT 

The difficulty of modifying mental disorders is in part due to the fact that the 
patient is only seen at a late stage of the disorder when the modes of thought and 
behaviour have become fixed and when the situation has lost some of its plasticity. 
A constant effort is being made throughout the community to see by what means 
those in need of help may at an early stage be steered in the right direction. This 
is no easy task for as a rule the person in need of help is often the last to recognize 
it and the first to resent the suggestion that he should apply for help. It is no easy 
task in the school or college, in the factory or in the office to organize the necessary 
first-aid treatment and to make such a first-aid unit a familiar and acceptable 
source of consultation. The out-patient department of the hospital is a first-aid 
station where one offers assistance to those who are not sick enough to require 
admission to the hospital and who are able to carry on their usual program in the 
home, at school or in industry. Some patients have heard of the department from 
friends and come up spontaneously to get advice. Others are referred by teachers, 
physicians, nursing organizations, family welfare organizations. 

A great many of the patients are children. In many of the children the basal 
factor is some fundamental defect, either congenital or acquired in infancy. In 
many other cases the problem is one of behaviour or of the nervous balance of the 
child. The nervous child is very rarely the problem of an isolated unit but is a 
problem of family life, and the full investigation of the symptoms involves a re- 
view of the total situation and often means bringing important help to the parents 
in regard to problems of their own lives. 

The examination of the child is no easy matter and differs considerably from 
that of the adult. The child has to be approached in a much less formal manner 



12 



P.D. 137 



and his inner life and preoccupations are more likely to be expressed in play, in 
drawing and in spontaneous activities than in responses to a series of formal ques- 
tions. Both the nature of the nervous disorders of childhood and the methods 
which are most suitable to their analysis are important problems for investigation. 

On the Social Service Department 

A mental disorder in distinction from the ordinary run of bodily ailments has 
to be considered as one phase of the reaction of an individual to the demands of 
the actual life situation. The study and treatment of the individual case, therefore, 
involves not only the systematic examination of the physiological functions and 
the psychology of the individual but also of the environmental factors which enter 
into the life of the patient. A thorough reconstruction of the environmental situa- 
tion is often an essential part of the study of the nervous symptoms of childhood, 
of a child's misbehaviour or delinquencj'-, of an adult's depression or suspicion. 

The physician is seldom in a position to make this investigation personally and 
must rely upon trained workers who have the necessary tact and special experience. 
Such an ancillary service is necessary not only for the complete study of the patient 
but also for the consistent treatment of the patient. The cure of the patient is 
measured not by such simple tests as in a physical bodily ailment where the blood 
count, the temperature, the weight, the urine may give the necessary indication to 
the physician of restored balance. The recovery of the mental patient is measured 
by the way in which he responds to the actual demands of life and adapts himself 
to the home, the neighborhood, the group, the working environment, the general 
social demands. 

To give the patient the best chance of readaptation it is very often desirable that 
the patient should get a certain amount of assistance and direction on his return to 
ordinary life. The sympathetic insight and tact of those around him may be an 
important factor in determining the success of his return to the environment. 
Interviews with the teacher, with a parent, with the spouse or with the employer 
may prevent unnecessary setbacks and relapses, and contact of the social worker 
with the environment for a reasonable period is a very valuable safeguard. 

The report from the social service department gives a good view of the concrete 
details which are covered by such a general statment, and shows how the work of 
the hospital fits in to many of the other sDcial activities of the community. 

A heavy demand is made upon this department by the court cases which are 
referred to the hospital for study and diagnosis. In all these cases the social back- 
ground has to be carefully reviewed and the data thus gathered play a very impor- 
tant part in the diagnosis and general appreciation of the case. 

The workers in this department serve, to a large extent, as liaison officers between 
the hospital and other organized activities of the community, and even a glance at 
the analysis of the work given at the end of the social service report will show 
clearly how many of the everyday difficulties of life throughout the community 
come under the scrutiny and the helpful guidance of the social worker. 

On the Care of the Patients 

The study and care of the patient is not the problem of the physician alone, but 
requires the assistance of trained workers of different types. 

The patients require the care of nurses trained not only in the ordinary duties 
of the bedside nurses but also sensitive to the special needs of individuals who are 
emotionally disturbed and who may have a distorted attitude to those around 
them. 

Special forms of treatment of benefit to the general physique of the patient re- 
quire an appropriate equipment and skilled personnel. Thus baths of different 
types are freely made use of, and the staff has had the benefit of a systematic course 
of instruction in hydrotherapy by Dr. Rebekah Wright, the hydrotherapeutist of 
the Massachusetts Department of Mental Diseases. Treatment by means of other 
physical agencies, by heat and by light are also available for suitable cases. 

The treatment of the patient in the hospital is, however, not confined to special 
psychotherapeutic interviews and to special measures of physical hygiene, but is 
also kept in mind in the patient's daily program of activity. Limitations of space 
and of personnel restrict very severely the psosibilities in this direction. Theoreti- 



►.D. 137 

ally, one would like to give a patient each day a total program in which construc- 
ve activity, rest and recreation would be well balanced. Unfortunately there 
m little possibility of wholesome outdoor activity in the open air and of the use oi 
rhat Sir Thomas Clouston referred to as the greatest therapeutic instrument — 
he wheelbarrow. Occupation has, therefore, to be very largely indoor occupation, 
nd is available for a comparatively few hours each day to the individual patient. 
Vithin these limitations, however, the occupational personnel contribute a valuable 
ervice in stimulating the interest of patients, in encouraging satisfaction from ob- 
ective tasks, directing constructive efforts, fostering native skill, withdrawing 
nergy from idle daydreams or unwholesome preoccupations to simple tasks carried 
ut with the group in a cheerful atmosphere. 

On Research 

Reference has already been made to the importance of the spirit of scientific 
uriosity and to the necessity of combining service to the patients with mvesti- 
rative activity. The detailed reports from the different departments and the 
iibliography at the end indicate the lines along which special investigative work 
las been carried on during the past year. . ^ r 

There has been brought together in book form a collection of reprints of the 
;tatistical studies on schizophrenia which have been carried on at the Boston 
Psychopathic Hospital since 1927 with the aid of funds derived from outside 
sources. Such studies may seem rather cold and austere, remote from the real 
Droblems of the individual case, dealing to a certain extent with scientific method 
•ather than with the stuff of human life. They represent, however, one form of 
investigative activity which is concerned not so much with the results of investi- 
zation as with the accuracy and keenness of the tools which other mvestigators 
must necessarily use. They represent, therefore, a very fundamental piece of work, 
[n the course of this work the various collaborators were forced to become more 
precise in their use of terms, more clear in the formulation of problems, more 
systematic in their grasp of the raw material of their observations. This investiga- 
tion has done much, therefore, to prepare the way for the more specific investigation 
of the detailed mechanisms in those cases which are called schizophrenic, patients 
who form a large proportion of those failures in adaptation which tend to accumu- 
late in the state hospitals. . u ^ v,; 

A very different approach to the problems of the schizophremc but one which 
is in no way inconsistent is that represented by the work which is referred to in the 
reports of Dr. Solomon and Dr. d'Elseaux. Here it is not a question of reviewing 
statistically hundreds or thousands of cases in order to see the general principles 
which underly the development of these disorders. It is a problem of the analysis 
of the individual cases with the most precise methods available to see whether the 
disorder of adaptation to demands of human life may be due to some subtle dis- 
turbance of the fundamental chemical and physiological life processes. 

At the other extreme from the detailed life processes studied by Dr d Elseaux 
are the more complicated functions which are studied in the psychological laboratory 
by Dr Wells and his group. Here special problems have been taken up partly on 
account of their technical interest, partly on account of their immediate practical 
importance. The psychologist has much to say about the diflficulties of childhood, 
especially with those difficulties which are concerned with learning and the ac- 
quisition of skill, but also with difficulties of personal adaptation. 

Attention has for some time been concentrated in the laboratory on the special 
difficulties of reading which hamper many children. This topic has been made a 
further object of study during the past year, the nature of which study is indicated 
in the report from the laboratory. * u • n 

The condensed report of the head psychologist gives some hint of what is really 
an extensive program of investigation dealing with a variety of problems. The 
problem of adoption is a very practical problem involving the happiness of a group, 
and any assistance in dealing more efficiently with such a problem is to be wel- 
comed. Miss Jones has continued to devote much time to the study of those 
practical indications which may be of use in deciding the individual case. 



14 



P.D. 137^ 



On the General Administration of the Hospital j 

The reports from the various departments give a condensed statement of the 
various activities which are being carried on in the departments, these activities 
being coordinated to subserve the two main purposes of the hospital, service to the 
sick and investigation of the causes and treatment of mental disorders. | 

The practical demands made upon the hospital by the admission of approxi- 
mately two thousand patients annually, the complicated contacts with outside 
agencies and with the relatives of patients, the supervision of all the necessary 
formalities involved in the admission, discharge, commitment and transfer of 
patients, the coordination of the various services, the selection of employees, the, 
supervision of supplies entail a considerable administrative burden which falls on 
the Chief Executive Officer. This burden is all the greater because the Boston 
Psychopathic Hospital is somewhat different in its functions and organization 
from the ordinary state hospital, and with its very large admission rate and special 
relations to the community furnishes many special problems. 

During the major part of the past year Dr. Arthur N. Ball who from previous' 
experience was familiar with the working of the hospital was acting chief executive 
officer. He was thus able to insure the smooth running of the hospital by putting 
at its disposal his long experience. 

On September 16th Dr. Clifford D. Moore was appointed as Chief Executive 
Officer, coming from the Metropolitan State ilospital where he had done pioneer 
work as acting superintendent and where subsequently he had been assistant 
superintendent. 

It is appropriate here to express my appreciation for the loyal services which, 
during the past year have been given by the professional workers in their various] 
departments and by the employees of the hospital. The atmosphere of the hospital! 
is one of keen interest in professional problems and of willingness to see personal 
interests and claims in the perspective of a serious community service. 

In particular I wish to express my deep sense of personal obligation to Dr. Karl 
M. Bowman, chief medical officer, whose unremitting attention to the organization 
of the medical service, to the careful scrutiny of the clinical material and to the 
preparation of reports upon all cases referred from the courts deserves special 
commendation. 

I wish to thank the Board of Trustees for their continued interest in and atten- 
tion to the needs of the hospital and for their readiness at all periods to give their 
assistance in meeting special situations and difficulties. 

The hospital has just suffered a severe blow in the loss of a trustee, Dr. Allan 
W. Rowe, a genial personality, an indefatigable scientific worker, a man of the , 
broadest interests. Throughout his many years of trusteeship at the Boston 
Psychopathic Hospital he followed with keen interest the various phases of its 
activity and put generously at its dispoasl his own specialized knowledge. 

It is a pleasure to express appreciation of the support which during his term of 
office was afforded by Dr. James V. May, the retiring Commissioner of Mental 
Diseases, and which has been continued by his successor, the present Commissioner, 
Dr. Winfred Overholser whose appointment to this high office was very gratifying ( 
to his colleagues. 

Respectfully submitted, 

C. Macfie Campbell, 

Medical Director. 



D. 137 



15 



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P.D. 137; 




.D. 137 




18 



P.D. 137 



REPORT OF THE CHIEF EXECUTIVE OFFICER 
To the Board of Trustees and the Medical Director of the Boston Psychopathic Hospital: 
The position of Chief Executive Officer continued until September 17, 1934, to 
be filled by Dr. Arthur N. Ball, Assistant to the Commissioner of Mental Diseases, 
who had been assigned to the position in an acting capacity following the death of 
Dr. Samuel Smith Cottrell on July 16, 1933. The hospital owes a debt of gratitude 
to Dr. Ball for the benefit of his previous experience in the position and services 
during that time. 

A survey of the tables for the statistical year ending September 30 will show 
that the admissions were 2,000, the average daily population 75.42, and the total 
number of patients regularly committed to the hospital for longer periods of time 
than temporary care permits 136. The number transferred to Voluntary Status 
was 64. These figures are average for recent years and show little change from 
corresponding figures for the early years of the operation of the hospital as an in- 
dependent unit. The highest admission rate is noted for the months of April, May 
and August. At no time during the year was there any overcrowding. These 
statistics would seem to indicate that full utilization of the 110 bed capacity had 
not been made, but in actual practice, and as a survey of the daily reports will 
indicate, there are occasions when the facilities of the hospital are taxed so that a 
safety margin of available beds must be maintained. 

The current appropriation for maintenance purposes has been found adequate 
to meet the essential needs of the hospital. There still continues a definite and 
necessary legislative policy of strict economy in public expenditures. This policy 
has not reacted unfavorably as regards the providing of essentials for the welfare 
of patients, but it has prevented the carrying out of a normal program of repairs 
and renovations. In 1926 certain plans were projected for a building program for 
the hospital. Since 1931 the hospital has gone on record yearly as desiring the 
fulfillment of this program. At this time the administration of the hospital feels 
that if funds can be made available through public works sources, a detached resi- 
dence for staff and employees is needed, together with funds for alterations in the 
hospital plant to modernize it and so permit of facilities for a rapidly expanding 
psychiatric field both in treatment and research. 

The outstanding change in the hospital plant has been a reallocation of laboratory 
space. In March work was commenced which was finally completed in September 
so that there is now a set-up of clinical and research laboratories on one floor. 
The cost of alterations was met by a contribution of $2,700 from Harvard Medical 
School, F.E.R.A. labor in the amount of $304.05, and the remainder from the 
hospital maintenance budget. Repairs and Renewals items for the year were: 
(Ventilating equipment and partition in cafeteria and staff dining room; (2) Copper 
screens with welded frames in kitchen and dining room; (3) two powers thermo- 
static water controllers for admission wards; (4) Blodgett Gas Oven complete with 
heat control; (5) Hobart Slicing Machine Model No. 111. 

Requests for the same item of the 1935 budget are as follows: (1) Copper welded 
screens for Ward 5 and Pool Room adjoining; (2) chain link fence for back yard; 
(3) hood for toaster and tea and coffee urns; (4) Soundproofing hydro rooms — 
Ward 3; (5) brick enclosure for garbage receptacles; (6) enlarge sitting room 
space Ward A; (7) new ammonia condenser; (8) repair of roof. 

Current economic and social conditions have been reflected in hospital activities. 
A definite decrease in the income of the hospital for the board of patients is noted. 
The reason is not at all obscure although one gets the impression that there is a 
growing tendency towards a dependence on social and governmental agencies for 
the expenses of hospitalization. This tendency is responsbile for an additional 
problem for hospital administrators, not so much in the case of this hospital, which 
is not directly dependent on such income, but rather in meeting the demands, at 
times unreasonable, of individuals for special services. The trend is reflected in 
the increasing requests of both old established and newly organized social agencies 
for information on patients. Such requests are in turn reflected in an increase in 
work of the clerical staff. Repeal of prohibition has undoubtedly changed the 
complexion of psychiatric problems on the hospital wards. 

The turnover of hospital personnel is less than in former years although frequent 
changes continue to occur in non-professional groups. The morale of employees, 



P.D. 137 



19 



particularly in the lower brackets, has improved with a one-third restoration of 
salary decreases as of April 1, and the promise of full restoration as of December 1. 
There has been in general an appreciation on the part of hospital employees that 
they have enjoyed regular positions and full time employment. 

Record should be made of the retirement of Dr. Charles G. Dewey and Dr. 
William H. Prescott from their positions as committing physicians for Suffolk 
County, the former in May and the latter in June. The relationship between 
them and the hospital over a period of years has been a most pleasant one and it 
was with keen regret that it was terminated. The vacancies so created have been 
filled by Dr. Charles B. Sullivan and Dr. Nathan Garrick who carry on in the same 
cooperative manner. Elizabeth Libber Shore, treasurer, for the institution retired 
March 3, 1934, after a service of eleven years and her position was filled by Anna 
F. Caulfield who had served as assistant to the treasurer for three and one-half 
years. Elveretta Blake who has filled the position of senior library assistant since 
1922 retires at the end of the present year, having attained the retirement age. 

I wish to express my appreciation for the cooperation extended to me by the 
Department of Mental Diseases, the Board of Trustees, and the entire hospital 
personnel during the brief period of my present incumbency. 

Respectfully submitted, 

Clifford D. Moore, M.D. 

Chief Executive Officer. 

REPORT OF THE OUT-PATIENT DEPARTMENT 
To the Medical Director of the Boston Psychopathic Hospital: 

I herewith submit the annual report of the Out-patient Department for the 
year ending November 30, 1934. 

The staff of the clinic during the past year was as follows: 

Dr. C. Macfie Campbell, Medical Director of the Hospital. 

Dr. Oscar J. Raeder, Chief of Out-Patient Department. 

Dr. Mary Palmer, Assistant Physician. 

Dr. Charles Sullivan, Assistant Physician to May 1, 1934. 

Dr. Charles H. Kimberly, Assistant Physician, June 2, to July 19, 1934. 

Dr. Irma Bache, Assistant Physician from September 1, 1934. 

Miss Annie C. Porter, Clinic Manager. 

Special Workers: Dr. Henry B. Elkind, Dr. Ella Prescott Cahill, Dr. Jessie D. 
Campbell, Dr. Arthur McGugan, Dr. Merrill Moore, Dr. Hortensia A. F. Robinson, 
Dr. Myer Brody, Dr. Hyman Millen, Dr. K. Dabrowski, Dr. Marjorie Meehan, 
Dr. J. Finesinger, Dr. William J. Roth, Jr., Dr. Conrad Wall. 

Students: Mr. Reed Harwood, H.M.S., IV. 

During the fiscal year 1933-34 there were 775 new patients, an increase over 
last year of 23 patients, and 293 old patients, a total of 1,068. Of the new patients 
370 were male, and 405 were female. Among the 370 males 186 were adults, 64 
were adolescents (14 to 18 years inclusive), and 120 were children. Of the 405 new 
female patients 237 were adults, 93 were adolescents, and 75 were children. 

Visits made by 775 new patients number 1,830. Old patients made 1,028 visits, 
a total of 2,858 clinic visits. 

The reasons for consulting the clinic were numerous, as usual. For convenience 
they have been grouped under the following headings: (a) behavior, 167 patients; 
(b) domestic, 30 patients; (c) education, 72 patients: (d) neuropathic, 404 patients; 
(e) personality, 5 patients; (f) routine examinations, 48 patients; (g) vocational, 
17 patients; (h) miscellaneous, 32 patients. 

The most frequent were those with neuropathic conditions. Among these we 
find patients complaining of pains, definite or vague, in various parts of the body, 
etc. A large number of these were psychoneurotic individuals. School problems, 
conduct and behavior disorders in which mental defect is a common factor composed 
another large group, 72 patients. (See table.) 

Patients were referred from various sources as follows: Social agencies, 290; 
Other hospitals, 137; Private physicians, 107; Relatives and friends, 101; Own 
initiative, 35; School, 30; Boston Psychopathic Hospital, 26; Court, 27; Depart- 
ment of Mental Diseases, 4; Others, 18. 



20 



P.D. 137 



The diagnoses have been rearranged to conform as much as possible to the newf 
grouping adopted at the last annual meeting of the American Psychiatric Asso- 
ciation in New York in 1934. Additional classifications are here added only where 
it is necessary to cover the different types of cases (out-patient cases) not includedi 
in the official list. (See 1934 edition of State Hospital Manual). 

Among the diagnoses the largest group was that of the psychoneuroses, 132 
patients, of which 61 were male and 71 female. The next group in point of numbers 
is that of the feebleminded, a total of 124 patients, 66 males and 58 females. 01 
these the great majority fell in the moron and borderline classes. Eighty-six 
patients in the combined groups were about equally divided between the sexes. 
There were 4 cases of Mongolism. In the manic-depressive group there were 36 
new cases, 11 males and 25 females. Hospital treatment was advised for most of 
them; a few were treated at the clinic. Likewise among the psychoneurotic 
groups a large number of the reactive depressions which may be difficult to differ-- 
entiate from manic-depressive depressions were referred for treatment in the 
hospital. Of these, however, the greater number were successfully treated in the 
Out-patient Department. 

We feel that the economic depression with resultant unemployment and conse- 
quent family worries was again a special factor in the causation of many of the 
depressions in both these groups. 

The schizophrenic types numbered 29 cases, 16 males and 13 females. Among 
the unclassified subdivisions are included a large number of incipient psychotic 
states tentatively diagnosed Schizophrenia. These cases were almost all referred 
to the Boston Psychopathic Hospital where continuous observation and more 
careful study is available. The clinic has also been following up several cases of 
schizophrenia who have been discharged from state hospitals, including the Boston 
Psychopathic Hospital. 

The contribution of the psychological department to the out-patient work has^ 
again been a large and important part of the clinic activity. Among the cases! 
tested there were found IS patients with '"superior" or ''very superior" intelli- 
gence. Of these, 3 cases were conduct problems which furnished the motive for con- 
sultation. One of these ''very superior" patients is notable in that he showed 
remarkably poor judgment in his serious intention of marrying a girl of moron 
intelligence. On the other hand, we recently had a patient, an adolescent girl of 
17 with dull normal intelligence according to tests, who showed good enough 
judgment to complain to the poHce and succeed in leaving a home in which the 
mother was sexually immoral. Such cases serve to emphasize the importance of 
clinical psychiatric judgment in the interpretation of intelligence quotients. 

A large group, 62 cases, under behaviour disorders is that of so-called "adult 
maladjustment". Here we have included marital problems where incompatibility 
of temperament or atypical personahty makeup may be causative factors. Some 
cases of sex delinquency — unmarried mothers — are also listed in this category. 
There were in all 44 women in this group. 

The child guidance clinic has continued to treat childhood problems and many 
of these cases are included under '" primary behaviour disorders in children '. There 
were 43 such cases, 21 boys and 22 girls. Children with neurotic traits numbered 
46, about evenly divided in sex. Enuresis, temper tantrums, phobias, nail biting, 
with various types of misconduct and sex problems, masturbation, etc. are prom- 
inent complaints in this group. The Social Service has been of much help in getting 
information about home conditions and in teaching parents the psychiatric tech- 
niques necessary for the treatment of these frequently stubborn conditions. 

A small group of reading problems, especially in children of average intelligence, 
has attracted the attention of Dr. Wells and his staff who have given time to follow; 
and treat some of these conditions. 

For other groups see table of diagnoses. , 

Dr. Palmer and Miss Viola Jones of the psychology department made a school, 
survey during the months of May and June in one of the Reading Schools at thei 
request of the Superintendent through Dr.